Healthcare Provider Details

I. General information

NPI: 1831775493
Provider Name (Legal Business Name): BEHAVIOR ANALYSIS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 COUNTRY CLUB EST
SALEM IL
62881-3631
US

IV. Provider business mailing address

109 COUNTRY CLUB EST
SALEM IL
62881-3631
US

V. Phone/Fax

Practice location:
  • Phone: 314-740-5639
  • Fax:
Mailing address:
  • Phone: 314-740-5639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ADEDAYO MOJEED ADENEKAN
Title or Position: PRESIDENT
Credential: BCBA
Phone: 314-740-5639