Provider Demographics
NPI:1811357510
Name:ORSO, BRANDON SCOTT (BCBA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:ORSO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-0331
Mailing Address - Country:US
Mailing Address - Phone:337-233-1167
Mailing Address - Fax:337-233-1168
Practice Address - Street 1:300 PARK WEST DR
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8911
Practice Address - Country:US
Practice Address - Phone:337-233-1167
Practice Address - Fax:337-233-1168
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-143103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst