Healthcare Provider Details

I. General information

NPI: 1013898329
Provider Name (Legal Business Name): PEDIATRIC BEHAVIOR SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 REMINGTON LN
SAINT LOUIS MO
63144-2134
US

IV. Provider business mailing address

2424 REMINGTON LN
SAINT LOUIS MO
63144-2134
US

V. Phone/Fax

Practice location:
  • Phone: 618-420-6686
  • Fax:
Mailing address:
  • Phone: 618-420-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TRACY BRAMBLETT
Title or Position: OWNER, BCBA
Credential: MS
Phone: 618-420-6686