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General NPI Number Information
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NPI Number | 1679010094
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Entity Type | Organization
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Legal Business Name | LEARNING MOMENTUM
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 1000 EDGEWATER PT STE 103
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2954
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Country | US
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Telephone | 636-265-1721
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Fax |
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Provider Business Mailing Address
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Address Line | 2314 HIGHWAY C
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City | OLD MONROE
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State | MO
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Zip | 63369-2404
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Country | US
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Telephone | 636-665-5191
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. AMELIA JEAN BUIE
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Credential | BCBA
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Telephone | 636-448-3872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2011005433
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License Number State | MO
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