Provider Demographics
NPI:1174818868
Name:ADVANCED BEHAVIORAL PSYCHOLOGISTS INC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL PSYCHOLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-821-4357
Mailing Address - Street 1:10000 WATSON RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1854
Mailing Address - Country:US
Mailing Address - Phone:314-821-4357
Mailing Address - Fax:314-822-9255
Practice Address - Street 1:10000 WATSON RD
Practice Address - Street 2:SUITE S
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1854
Practice Address - Country:US
Practice Address - Phone:314-821-4357
Practice Address - Fax:314-822-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00116103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty