Provider Demographics
NPI:1417657362
Name:SHINE ON THE SPECTRUM
Entity Type:Organization
Organization Name:SHINE ON THE SPECTRUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:318-664-9801
Mailing Address - Street 1:306 PAPPA JOE DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4953
Mailing Address - Country:US
Mailing Address - Phone:318-664-9801
Mailing Address - Fax:
Practice Address - Street 1:714 E KALISTE SALOOM RD STE C1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2530
Practice Address - Country:US
Practice Address - Phone:318-664-9801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty