NPI 1245702869 · live from the CMS NPI Registry
Mackenzie Archambo
Behavior Analyst in O Fallon, IL. National Provider Identifier 1245702869, active.
NPI record
| NPI | 1245702869 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 634 N Main St, O Fallon, IL 62269 |
| Practice phone | 618-726-0701 |
| Mailing address | 21600 Oxnard St Ste 1800, Woodland Hills, CA 91367 |
| Enumerated | December 20, 2018 |
| Last updated | December 20, 2018 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst primary | 103K00000X | A625-5419-9602 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.