Healthcare Provider Details

I. General information

NPI: 1700484441
Provider Name (Legal Business Name): TAYLOR MARIE PETERS BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR MARIE LAUER BCBA

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N HARPER ST
MONTGOMERY CITY MO
63361-1721
US

IV. Provider business mailing address

513 N HARPER ST
MONTGOMERY CITY MO
63361-1721
US

V. Phone/Fax

Practice location:
  • Phone: 636-359-8183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2021029720
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: