Healthcare Provider Details
I. General information
NPI: 1790952158
Provider Name (Legal Business Name): GREAT STRIDES BEHAVIORAL CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/14/2008
Last Update Date: 08/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2560 METRO BLVD
MARYLAND HEIGHTS MO
63043-2417
US
IV. Provider business mailing address
2560 METRO BLVD
MARYLAND HEIGHTS MO
63043-2417
US
V. Phone/Fax
- Phone: 314-715-3855
- Fax: 314-447-6520
- Phone: 314-715-3855
- Fax: 314-447-6520
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MS.
AMY
R.
LEUTHAUSER
Title or Position: CEO
Credential: BCBA, LBA
Phone: 636-841-1482