Provider Demographics
NPI:1821746462
Name:THIBODEAUX, RICHARD SETH
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SETH
Last Name:THIBODEAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 ELLERBE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7730
Mailing Address - Country:US
Mailing Address - Phone:318-629-1732
Mailing Address - Fax:318-629-2735
Practice Address - Street 1:10450 ELLERBE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7730
Practice Address - Country:US
Practice Address - Phone:318-629-1732
Practice Address - Fax:318-629-2735
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician