=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083238729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLAS BEHAVIOR SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2020
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 JEFFERSON ST STE 118
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62301-5654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-275-0370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 JEFFERSON ST STE 118
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62301-5654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-275-0370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
-----------------------------------------------------
Name | MRS. JACQUELINE EVONNE HILDEBRAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-617-9835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------