Provider Demographics
NPI:1871929802
Name:GILCREASE, DAWN MARIE (BCBA)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:GILCREASE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 KEYSTONE LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5916
Mailing Address - Country:US
Mailing Address - Phone:985-232-6346
Mailing Address - Fax:
Practice Address - Street 1:7835 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3112
Practice Address - Country:US
Practice Address - Phone:985-872-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2375300Medicaid