Provider Demographics
NPI:1154692333
Name:FAVRE, CHAD (MS, BCBA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:FAVRE
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5328
Mailing Address - Country:US
Mailing Address - Phone:985-502-1884
Mailing Address - Fax:
Practice Address - Street 1:800 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5328
Practice Address - Country:US
Practice Address - Phone:985-502-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst