Provider Demographics
NPI:1942815360
Name:OWL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:OWL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:636-224-6224
Mailing Address - Street 1:447 THURWELL ST
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-1131
Mailing Address - Country:US
Mailing Address - Phone:636-232-1016
Mailing Address - Fax:
Practice Address - Street 1:4051 JEFFCO BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-4261
Practice Address - Country:US
Practice Address - Phone:636-223-0070
Practice Address - Fax:636-323-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO730087100Medicaid