Healthcare Provider Details

I. General information

NPI: 1568019800
Provider Name (Legal Business Name): ERIN MCDANIEL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN GOLLUBSKE

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 E 20TH ST
JOPLIN MO
64801-5852
US

IV. Provider business mailing address

11933 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3203
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-3616
  • Fax: 417-781-4190
Mailing address:
  • Phone: 314-394-7100
  • Fax: 314-567-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36747
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36747
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: