Healthcare Provider Details

I. General information

NPI: 1265998652
Provider Name (Legal Business Name): CHILDREN'S BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E. TRISH KNIGHT STREET STE 1 & 2
WEST PLAINS MO
65775-2644
US

IV. Provider business mailing address

PO BOX 683
WILLOW SPRINGS MO
65793-0683
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-6761
  • Fax: 417-815-9405
Mailing address:
  • Phone: 573-883-6761
  • Fax: 417-815-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA P RIVIELLO
Title or Position: OWNER
Credential: BCBA
Phone: 573-883-6761