Provider Demographics
NPI:1720487226
Name:NORTHPOINT PEDIATRIC BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:NORTHPOINT PEDIATRIC BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LBA
Authorized Official - Phone:318-243-6962
Mailing Address - Street 1:302 BARKER DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6544
Mailing Address - Country:US
Mailing Address - Phone:318-243-6962
Mailing Address - Fax:
Practice Address - Street 1:302 BARKER DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-6544
Practice Address - Country:US
Practice Address - Phone:318-243-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-063103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty