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General NPI Number Information
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NPI Number | 1306550413
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Entity Type | Organization
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Legal Business Name | TRY LOVE BEHAVIORAL CENTER, LLC
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 535 MAINE ST STE 13
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City | QUINCY
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State | IL
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Zip | 62301-3950
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Country | US
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Telephone | 217-577-2176
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Fax | 888-216-1181
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Provider Business Mailing Address
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Address Line | 535 MAINE ST STE 13
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City | QUINCY
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State | IL
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Zip | 62301-3950
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Country | US
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Telephone | 217-316-6656
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARISSA JO LUMPKIN
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Credential | BCBA
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Telephone | 217-577-2176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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