=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407697618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 99BILLION BETTER BEHAVIOR SUPPORT & LEARNING CENTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 EDMAR LN
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63138-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-614-7062
-----------------------------------------------------
Fax | 314-473-1094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 EDMAR LN
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63138-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 341-614-7062
-----------------------------------------------------
Fax | 314-473-1094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANNETTA SYKES
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 314-614-7062
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------