Provider Demographics
NPI:1538807730
Name:FURMAN, TODD MICHAEL (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:FURMAN
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 MCCAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-8743
Mailing Address - Country:US
Mailing Address - Phone:337-274-3949
Mailing Address - Fax:
Practice Address - Street 1:1924 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4131
Practice Address - Country:US
Practice Address - Phone:337-240-8162
Practice Address - Fax:337-240-8163
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-58867103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-22-58867OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)
LAL-642OtherLOUISIANA BEHAVIOR ANALYST BOARD (LBAB)