Healthcare Provider Details

I. General information

NPI: 1306550413
Provider Name (Legal Business Name): TRY LOVE BEHAVIORAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAINE ST STE 13
QUINCY IL
62301-3950
US

IV. Provider business mailing address

535 MAINE ST STE 13
QUINCY IL
62301-3950
US

V. Phone/Fax

Practice location:
  • Phone: 217-577-2176
  • Fax: 888-216-1181
Mailing address:
  • Phone: 217-316-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARISSA JO LUMPKIN
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 217-577-2176