Healthcare Provider Details

I. General information

NPI: 1285932335
Provider Name (Legal Business Name): BEHAVIORAL SCIENCE INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2011
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MARKET PLACE SUITE 206
FAIRVIEW HEIGHTS IL
62208
US

IV. Provider business mailing address

12685 DORSETT RD #339
MARYLAND HEIGHTS MO
63043-2100
US

V. Phone/Fax

Practice location:
  • Phone: 314-607-2573
  • Fax:
Mailing address:
  • Phone: 314-607-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIE CLARK
Title or Position: DIRECTOR.THERAPIST
Credential: M.A.
Phone: 314-607-2573