Provider Demographics
NPI:1437880416
Name:COMEAUX, JERRICK (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JERRICK
Middle Name:
Last Name:COMEAUX
Suffix:
Gender:M
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8309
Mailing Address - Country:US
Mailing Address - Phone:337-456-5705
Mailing Address - Fax:337-456-6249
Practice Address - Street 1:170 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8309
Practice Address - Country:US
Practice Address - Phone:337-456-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-22-59436103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst