MEDICARE: LINDSEY HOLTSMAN BCBA, LBA

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	103K00000X	Behavior Analyst	1-24-70538	MO

General Provider Information

NPI Number	:	1518737170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY HOLTSMAN BCBA, LBA

Provider Business Mailing Address
First Line	:	16299 AUDUBON VILLAGE DR
Second Line	:
City	:	GROVER
State	:	MO
Zip	:	63040-1712
Country	:	US
Telephone Number	:	314-740-7335
Fax Number	:

Provider Business Practice Location Address
First Line	:	11780 BORMAN DR STE 400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4135
Country	:	US
Telephone Number	:	314-275-0506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/04/2024

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