Healthcare Provider Details

I. General information

NPI: 1740801869
Provider Name (Legal Business Name): DEVELOPING MINDS THERAPY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CITYPLACE DR STE 200
SAINT LOUIS MO
63141-7055
US

IV. Provider business mailing address

2 CITYPLACE DR STE 200
SAINT LOUIS MO
63141-7055
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-0306
  • Fax: 314-689-0306
Mailing address:
  • Phone: 314-626-0306
  • Fax: 314-689-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LENELL E KELLEY
Title or Position: OWNER
Credential: MAP, BCBA, LBA
Phone: 314-626-0306