Provider Demographics
NPI:1295485514
Name:DEVILLIERS, KEITH JR (BCBA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:DEVILLIERS
Suffix:JR
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 1:1021 THALIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4134
Mailing Address - Country:US
Mailing Address - Phone:063-816-2004
Mailing Address - Fax:
Practice Address - Street 1:1021 THALIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4134
Practice Address - Country:US
Practice Address - Phone:063-816-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA621103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst