Provider Demographics
NPI:1114613296
Name:MAXVILLE & ASSOCIATES
Entity Type:Organization
Organization Name:MAXVILLE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MAXVILLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD, BCBA-D, LBA
Authorized Official - Phone:573-864-9743
Mailing Address - Street 1:5900 GALLI LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-5836
Mailing Address - Country:US
Mailing Address - Phone:573-864-9743
Mailing Address - Fax:
Practice Address - Street 1:5900 GALLI LN
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-5836
Practice Address - Country:US
Practice Address - Phone:573-864-9743
Practice Address - Fax:636-245-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty