Provider Demographics
NPI:1760937783
Name:MCCORMACK, JOSHUA (BCBA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MCCORMACK
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 1:1003 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2135
Mailing Address - Country:US
Mailing Address - Phone:318-237-8216
Mailing Address - Fax:
Practice Address - Street 1:1003 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2135
Practice Address - Country:US
Practice Address - Phone:318-237-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA160103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst