Provider Demographics
NPI:1710429469
Name:BERNARD, MORGAN (LBA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 DEMANADE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2508
Mailing Address - Country:US
Mailing Address - Phone:337-534-8679
Mailing Address - Fax:337-534-0027
Practice Address - Street 1:132 DEMANADE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2508
Practice Address - Country:US
Practice Address - Phone:337-534-8679
Practice Address - Fax:337-534-0027
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-176103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst