NPI 1366045635 · live from the CMS NPI Registry
Mandy Michelle Basham, BCaBA
Behavior Analyst in Springfield, MO. National Provider Identifier 1366045635, active.
NPI record
| NPI | 1366045635 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 3048 S Clifton Ave Ste 112, Springfield, MO 65807 |
| Practice phone | 417-818-5784 |
| Enumerated | November 19, 2020 |
| Last updated | July 8, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Assistant Behavior Analyst | 106E00000X | 0-23-14446 (MO) |
| Behavior Technician | 106S00000X | RBT-20-143411 (MO) |
| Behavior Analyst primary | 103K00000X | 2024025674 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.