Healthcare Provider Details

I. General information

NPI: 1235602285
Provider Name (Legal Business Name): BEHAVIORAL HEALTH AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17375 STATE RTE N
SAINT MARY MO
63673-9031
US

IV. Provider business mailing address

17375 STATE RTE N
SAINT MARY MO
63673-9031
US

V. Phone/Fax

Practice location:
  • Phone: 573-535-8315
  • Fax: 314-200-2167
Mailing address:
  • Phone: 573-535-8315
  • Fax: 314-200-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LORI ANN BAUMAN
Title or Position: OWNER
Credential: LCSW, BCBA
Phone: 573-535-8315