Healthcare Provider Details

I. General information

NPI: 1154876563
Provider Name (Legal Business Name): MARTY DEWAYNE PRICE PHD, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W MAIN ST
MARION IL
62959-1137
US

IV. Provider business mailing address

902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US

V. Phone/Fax

Practice location:
  • Phone: 877-467-3123
  • Fax: 618-681-6824
Mailing address:
  • Phone: 618-326-2772
  • Fax: 618-937-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.001252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: