Provider Demographics
NPI:1588150999
Name:GOTHREAUX, COLBY THOMAS (MS BCBA)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:THOMAS
Last Name:GOTHREAUX
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 1:1802 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5722
Mailing Address - Country:US
Mailing Address - Phone:337-308-8711
Mailing Address - Fax:
Practice Address - Street 1:1802 WILSON DR
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5722
Practice Address - Country:US
Practice Address - Phone:337-308-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst