Active NPI
Amy Theobald
- Behavior Analyst
- Grand Coteau, LA
National Provider Identifier
1265877450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-13-14414
- Practice address
- 280 Lloyd Lewis
Grand Coteau, LA 70541 - Phone
- (337) 356-6006
- NPI assigned
- May 1, 2013
- Last updated
- Nov 18, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-13-14414 | LA | Primary |
| Developmental Therapist | 222Q00000X | NU |
Addresses
Primary practice location
280 Lloyd Lewis
Grand Coteau, LA 70541
Mailing address
PO Box 444
Grand Coteau, LA 70541-0444
Phone (337) 356-6006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384732800000",
"number": "1265877450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 444",
"city": "GRAND COTEAU",
"state": "LA",
"postal_code": "705410444",
"telephone_number": "337-356-6006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 LLOYD LEWIS",
"city": "GRAND COTEAU",
"state": "LA",
"postal_code": "70541",
"telephone_number": "337-356-6006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEOBALD",
"first_name": "AMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-01",
"last_updated": "2013-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "LA",
"license": "1-13-14414",
"primary": true
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Coteau, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.