Healthcare Provider Details

I. General information

NPI: 1821408501
Provider Name (Legal Business Name): APPLIED BEHAVIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MCQUADE DR
SAINT PETERS MO
63376-7804
US

IV. Provider business mailing address

1601 MCQUADE DR
SAINT PETERS MO
63376-7804
US

V. Phone/Fax

Practice location:
  • Phone: 314-369-4235
  • Fax:
Mailing address:
  • Phone: 314-369-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2010043035
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2010043035
License Number StateMO

VIII. Authorized Official

Name: MRS. LISA ANNE GILBERTSEN
Title or Position: OWNER AND SENIOR BEHAVIOR ANALYST
Credential: MA, BCBA, LBA
Phone: 314-369-4235