Healthcare Provider Details

I. General information

NPI: 1710807755
Provider Name (Legal Business Name): ARIANA PAULINA CARRILLO-JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 HEADQUARTERS PARK
FENTON MO
63026-1910
US

IV. Provider business mailing address

3017 HENRIETTA ST
SAINT LOUIS MO
63104-1407
US

V. Phone/Fax

Practice location:
  • Phone: 636-405-2701
  • Fax:
Mailing address:
  • Phone: 831-524-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2025050127
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: