Provider Demographics
NPI:1124554175
Name:STOELB, MATTHEW (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:STOELB
Suffix:
Gender:M
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 SIERRA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-6100
Mailing Address - Country:US
Mailing Address - Phone:573-450-2903
Mailing Address - Fax:
Practice Address - Street 1:1061 SIERRA CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-6100
Practice Address - Country:US
Practice Address - Phone:573-450-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026723103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst