Provider Demographics
NPI:1629633987
Name:LITTLE ENGINES ABA CENTER LLC
Entity Type:Organization
Organization Name:LITTLE ENGINES ABA CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLILE
Authorized Official - Suffix:
Authorized Official - Credentials:LBA
Authorized Official - Phone:337-284-5800
Mailing Address - Street 1:2001 SOUTHWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4139
Mailing Address - Country:US
Mailing Address - Phone:337-284-5800
Mailing Address - Fax:337-313-4558
Practice Address - Street 1:2001 SOUTHWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4139
Practice Address - Country:US
Practice Address - Phone:337-284-5800
Practice Address - Fax:337-313-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2424301Medicaid