Healthcare Provider Details

I. General information

NPI: 1689396483
Provider Name (Legal Business Name): QUINCY EVAN HUFF BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 CRAIGSHIRE RD
SAINT LOUIS MO
63146-4036
US

IV. Provider business mailing address

5327 JAMIESON AVE APT A
SAINT LOUIS MO
63109-3350
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-0506
  • Fax:
Mailing address:
  • Phone: 615-779-6809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2022036294
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: