Provider Demographics
NPI:1639481799
Name:SAINT-LOUIS, PAUL GARRY (BCBA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GARRY
Last Name:SAINT-LOUIS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 CANOPY LOOP APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9457
Mailing Address - Country:US
Mailing Address - Phone:305-917-3169
Mailing Address - Fax:888-441-6806
Practice Address - Street 1:11503 CANOPY LOOP APT 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9457
Practice Address - Country:US
Practice Address - Phone:305-917-3169
Practice Address - Fax:888-441-6806
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-02-0503103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019955800Medicaid