Provider Demographics
NPI:1609306117
Name:GALJOUR, MALLORIE PAIGE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MALLORIE
Middle Name:PAIGE
Last Name:GALJOUR
Suffix:
Gender:F
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 1:580 LOTUS DR N APT 7
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6752
Mailing Address - Country:US
Mailing Address - Phone:985-507-3232
Mailing Address - Fax:
Practice Address - Street 1:19374 N 3RD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8813
Practice Address - Country:US
Practice Address - Phone:504-444-3647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-16
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-922103K00000X
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician