Provider Demographics
NPI:1669982518
Name:KURTZUBA, MAGGIE MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:MARIE
Last Name:KURTZUBA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 LINKSWILLER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-7573
Mailing Address - Country:US
Mailing Address - Phone:318-554-8348
Mailing Address - Fax:866-399-7694
Practice Address - Street 1:4019 COMMON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2942
Practice Address - Country:US
Practice Address - Phone:337-377-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-27869103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst