Provider Demographics
NPI:1780231589
Name:FAVRE, MARGARET NORDNESS (BCABA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:NORDNESS
Last Name:FAVRE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:LEE
Other - Last Name:NORDNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1928 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5843
Mailing Address - Country:US
Mailing Address - Phone:256-655-3922
Mailing Address - Fax:
Practice Address - Street 1:3999 US-190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-871-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC-046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2387103Medicaid