Provider Demographics
NPI:1336209311
Name:MAXVILLE, DALE ALLEN JR (PHD BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ALLEN
Last Name:MAXVILLE
Suffix:JR
Gender:M
Credentials:PHD BCBA-D
Other - Prefix:
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Mailing Address - Street 1:2743 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2137
Mailing Address - Country:US
Mailing Address - Phone:573-864-9743
Mailing Address - Fax:573-874-1723
Practice Address - Street 1:2743 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2137
Practice Address - Country:US
Practice Address - Phone:573-864-9743
Practice Address - Fax:573-874-1723
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst