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General NPI Number Information
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NPI Number | 1023375045
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Entity Type | Individual
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Provider Name | ALICE MARIE BLYTH MA, LPC, BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 04/15/2012
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Last Update Date | 04/15/2012
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Provider Practice Location Address
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Address Line | 3403 N BELTON AVE
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City | RIVERSIDE
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State | MO
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Zip | 64150-9502
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Country | US
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Telephone | 816-863-4542
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Fax |
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Provider Business Mailing Address
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Address Line | 3403 N BELTON AVE
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City | RIVERSIDE
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State | MO
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Zip | 64150-9502
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Country | US
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Telephone | 816-863-4542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2010007552
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2012010600
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License Number State | MO
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