Healthcare Provider Details

I. General information

NPI: 1285451195
Provider Name (Legal Business Name): KAREN L MARION BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 FAIRGROUND RD
NEOSHO MO
64850-1626
US

IV. Provider business mailing address

17641 HIGHWAY HH
NEOSHO MO
64850-6450
US

V. Phone/Fax

Practice location:
  • Phone: 417-451-8600
  • Fax:
Mailing address:
  • Phone: 417-825-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number2023007258
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: