Provider Demographics
NPI:1659020915
Name:VITALITY ABA
Entity Type:Organization
Organization Name:VITALITY ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:314-799-6922
Mailing Address - Street 1:2143 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-2620
Mailing Address - Country:US
Mailing Address - Phone:314-799-6922
Mailing Address - Fax:
Practice Address - Street 1:2143 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-2620
Practice Address - Country:US
Practice Address - Phone:314-799-6922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty