Provider Demographics
NPI:1598316903
Name:ROBERTS, ALICIA TALLEY (BCBA, LBA-507)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:TALLEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BCBA, LBA-507
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:T
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:512 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-6568
Mailing Address - Country:US
Mailing Address - Phone:337-739-8005
Mailing Address - Fax:
Practice Address - Street 1:512 THOROUGHBRED DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6568
Practice Address - Country:US
Practice Address - Phone:337-739-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC-044106E00000X
LALBA-507103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst