Provider Demographics
NPI:1104335512
Name:STEVENS, MEGAN PAP (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:PAP
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8862
Mailing Address - Country:US
Mailing Address - Phone:337-661-4041
Mailing Address - Fax:
Practice Address - Street 1:2912 WARREN AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8862
Practice Address - Country:US
Practice Address - Phone:337-661-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-17-27152103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty