Provider Demographics
NPI:1679010094
Name:LEARNING MOMENTUM
Entity Type:Organization
Organization Name:LEARNING MOMENTUM
Other - Org Name:RAGE TO REASON
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BUIE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:636-448-3872
Mailing Address - Street 1:2314 HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:OLD MONROE
Mailing Address - State:MO
Mailing Address - Zip Code:63369-2404
Mailing Address - Country:US
Mailing Address - Phone:636-665-5191
Mailing Address - Fax:
Practice Address - Street 1:1000 EDGEWATER PT STE 103
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-265-1721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011005433103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1-05-2152OtherBCBA