Provider Demographics
NPI:1134886930
Name:WITHERINGTON, GABRIEL MILAN (BCBA)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MILAN
Last Name:WITHERINGTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:206 E REYNOLDS DR STE F2
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2809
Mailing Address - Country:US
Mailing Address - Phone:318-224-7223
Mailing Address - Fax:318-415-1004
Practice Address - Street 1:206 E REYNOLDS DR STE J1
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2856
Practice Address - Country:US
Practice Address - Phone:318-224-7223
Practice Address - Fax:318-415-1004
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst