Provider Demographics
NPI:1528653664
Name:MILTON, CALEB JOHAN (RBT)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:JOHAN
Last Name:MILTON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 PARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5322
Mailing Address - Country:US
Mailing Address - Phone:318-655-8509
Mailing Address - Fax:
Practice Address - Street 1:2715 MACKEY PL STE 230
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2544
Practice Address - Country:US
Practice Address - Phone:318-779-1397
Practice Address - Fax:318-625-0586
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-155534106S00000X
LAR-8252106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician