MEDICARE: CHILDREN'S BEHAVIORAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1214365	OTHER	MO	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265998652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S BEHAVIORAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 683
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793-0683
Country	:	US
Telephone Number	:	573-883-6761
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 COUNTY ROAD 1270
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793-3393
Country	:	US
Telephone Number	:	573-883-6761
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. AMANDA P RIVIELLO
Credential	:	BCBA
Telephone Number	:	573-883-6761

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	05/04/2023

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Directions to “CHILDREN'S BEHAVIORAL SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

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