Provider Demographics
NPI:1518210871
Name:PEELER, ANGIE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:PEELER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44 PORTWEST CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5985
Mailing Address - Country:US
Mailing Address - Phone:636-493-9299
Mailing Address - Fax:636-493-9299
Practice Address - Street 1:44 PORTWEST CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5985
Practice Address - Country:US
Practice Address - Phone:636-493-9299
Practice Address - Fax:636-493-9299
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010042409103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst