Provider Demographics
NPI:1538788922
Name:FAIRBURN, DAVID ALAN JR (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:FAIRBURN
Suffix:JR
Gender:M
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19142 NULL RD
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-2516
Mailing Address - Country:US
Mailing Address - Phone:985-662-2594
Mailing Address - Fax:
Practice Address - Street 1:38450 SUNNY DAYS LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4603
Practice Address - Country:US
Practice Address - Phone:985-288-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-437103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-41607OtherBCBA CERTIFICATION
LAL-437OtherLBAB LICENSURE