Healthcare Provider Details

I. General information

NPI: 1285068080
Provider Name (Legal Business Name): ERIN MARIE PHIPPS BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GRAND AVE
JOPLIN MO
64801-2027
US

IV. Provider business mailing address

PO BOX 426
JOPLIN MO
64802-0426
US

V. Phone/Fax

Practice location:
  • Phone: 417-680-0777
  • Fax:
Mailing address:
  • Phone: 417-680-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2017042958
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: