Healthcare Provider Details

I. General information

NPI: 1760309272
Provider Name (Legal Business Name): BRAIN TO BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 EVRON CT
LAKE SAINT LOUIS MO
63367-1135
US

IV. Provider business mailing address

48 EVRON CT
LAKE SAINT LOUIS MO
63367-1135
US

V. Phone/Fax

Practice location:
  • Phone: 650-960-6054
  • 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

VIII. Authorized Official

Name: YING KRISTEN JIANG
Title or Position: OWNER
Credential: BCBA
Phone: 650-960-6054