Provider Demographics
NPI:1235602285
Name:BEHAVIORAL HEALTH AT HOME, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCBA
Authorized Official - Phone:573-535-8315
Mailing Address - Street 1:17375 STATE RTE N
Mailing Address - Street 2:
Mailing Address - City:SAINT MARY
Mailing Address - State:MO
Mailing Address - Zip Code:63673-9031
Mailing Address - Country:US
Mailing Address - Phone:573-535-8315
Mailing Address - Fax:314-200-2167
Practice Address - Street 1:17375 STATE RTE N
Practice Address - Street 2:
Practice Address - City:SAINT MARY
Practice Address - State:MO
Practice Address - Zip Code:63673-9031
Practice Address - Country:US
Practice Address - Phone:573-535-8315
Practice Address - Fax:314-200-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO730048655Medicaid