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General NPI Number Information
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NPI Number | 1720329865
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Entity Type | Organization
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Legal Business Name | BEHAVIOR THERAPY SPECIALISTS OF IL AND MO, LLC
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 126 W SARAH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63122-2646
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Country | US
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Telephone | 314-252-2069
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Fax | 314-698-2570
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Provider Business Mailing Address
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Address Line | 126 W SARAH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63122-2646
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Country | US
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Telephone | 314-252-2069
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Fax | 314-698-2570
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Authorized Official
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Title or Position | BEHAVIOR ANALYST/OWNER
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Name | JENNA DEE CUENCA
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Credential | BCBA
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Telephone | 314-252-2069
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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 | 111880
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License Number State | MO
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