Healthcare Provider Details

I. General information

NPI: 1194407387
Provider Name (Legal Business Name): THE MOMENTUM PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4837 HERITAGE HEIGHTS CIR
HAZELWOOD MO
63042-1593
US

IV. Provider business mailing address

4837 HERITAGE HEIGHTS CIR
HAZELWOOD MO
63042-1593
US

V. Phone/Fax

Practice location:
  • Phone: 636-544-3678
  • Fax:
Mailing address:
  • Phone:
  • 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 Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KIM DOWLING
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 636-544-3678