Provider Demographics
NPI:1912406232
Name:WELTY, NICOLETTE MARIE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:MARIE
Last Name:WELTY
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RUE BEAUREGARD STE F
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8511
Mailing Address - Country:US
Mailing Address - Phone:337-270-8585
Mailing Address - Fax:337-270-8588
Practice Address - Street 1:111 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3817
Practice Address - Country:US
Practice Address - Phone:337-270-8585
Practice Address - Fax:337-270-8588
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA103K00000X, 103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician