MEDICARE: BEHAVIORAL HEALTH AT HOME, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235602285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH AT HOME, LLC

Provider Business Mailing Address
First Line	:	17375 STATE RTE N
Second Line	:
City	:	SAINT MARY
State	:	MO
Zip	:	63673-9031
Country	:	US
Telephone Number	:	573-535-8315
Fax Number	:	314-200-2167

Provider Business Practice Location Address
First Line	:	17375 STATE RTE N
Second Line	:
City	:	SAINT MARY
State	:	MO
Zip	:	63673-9031
Country	:	US
Telephone Number	:	573-535-8315
Fax Number	:	314-200-2167

Authorized Official
Title or Position	:	OWNER
Name	:	LORI ANN BAUMAN
Credential	:	LCSW, BCBA
Telephone Number	:	573-535-8315

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	12/26/2023

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