Provider Demographics
NPI:1982475778
Name:FONTENOT, AUSTIN JON (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JON
Last Name:FONTENOT
Suffix:
Gender:M
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 1:1205 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2325
Mailing Address - Country:US
Mailing Address - Phone:337-580-6652
Mailing Address - Fax:
Practice Address - Street 1:400 6TH ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-3720
Practice Address - Country:US
Practice Address - Phone:337-468-3441
Practice Address - Fax:337-468-3440
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA803103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst