Provider Demographics
NPI:1578193249
Name:FRUGE, KIMBERLY BUCHLER (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BUCHLER
Last Name:FRUGE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 PINEY GROUNDS DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4890
Mailing Address - Country:US
Mailing Address - Phone:504-710-7320
Mailing Address - Fax:
Practice Address - Street 1:3999 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4914
Practice Address - Country:US
Practice Address - Phone:985-871-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-416103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3467275Medicaid