Healthcare Provider Details

I. General information

NPI: 1922910751
Provider Name (Legal Business Name): MARIGRACE BISHOP LBA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MADISON PARK DR
SAINT PETERS MO
63376-2289
US

IV. Provider business mailing address

6436 ALAMO AVE APT 1W
SAINT LOUIS MO
63105-3151
US

V. Phone/Fax

Practice location:
  • Phone: 314-537-0146
  • Fax:
Mailing address:
  • Phone: 816-560-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026002581
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: