1992426662 NPI number — MRS. AMELIA LAFARGUE FONTENOT M.A., LBA, BCBA

Table of content: MRS. AMELIA LAFARGUE FONTENOT M.A., LBA, BCBA (NPI 1992426662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992426662 NPI number — MRS. AMELIA LAFARGUE FONTENOT M.A., LBA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTENOT
Provider First Name:
AMELIA
Provider Middle Name:
LAFARGUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LBA, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAFARGUE
Provider Other First Name:
AMELIA
Provider Other Middle Name:
GRACE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992426662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27500 KINGS FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINDER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70648-4217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-335-8382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4019 COMMON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70607-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-377-6206
Provider Business Practice Location Address Fax Number:
866-399-7694
Provider Enumeration Date:
09/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  L-659 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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