Healthcare Provider Details

I. General information

NPI: 1689732620
Provider Name (Legal Business Name): BEHAVIOR INTERVENTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 METRO BLVD
MARYLAND HEIGHTS MO
63043-2412
US

IV. Provider business mailing address

2644 METRO BLVD
MARYLAND HEIGHTS MO
63043-2412
US

V. Phone/Fax

Practice location:
  • Phone: 314-395-9375
  • Fax: 314-395-9381
Mailing address:
  • Phone: 314-395-9375
  • Fax: 314-395-9381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY ANN SALLS
Title or Position: OWNER/DIRECTOR
Credential: BCBA, LBA
Phone: 314-609-5483