Healthcare Provider Details

I. General information

NPI: 1629925144
Provider Name (Legal Business Name): HEARTCORE ABA MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 RUE ROYALE ST
ST CHARLES MO
63301
US

IV. Provider business mailing address

1123 LOCUST ST STE 217
SAINT LOUIS MO
63101-1103
US

V. Phone/Fax

Practice location:
  • Phone: 917-232-4147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AKIBA KRUGER
Title or Position: CEO
Credential:
Phone: 917-232-4147