Provider Demographics
NPI:1124516950
Name:BEHAVIORAL SERVICES OF SOUTHERN ILLINOIS INC.
Entity type:Organization
Organization Name:BEHAVIORAL SERVICES OF SOUTHERN ILLINOIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:618-303-9282
Mailing Address - Street 1:7 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-8317
Mailing Address - Country:US
Mailing Address - Phone:618-303-9282
Mailing Address - Fax:618-319-1122
Practice Address - Street 1:7 BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-8317
Practice Address - Country:US
Practice Address - Phone:618-303-9282
Practice Address - Fax:618-319-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017015574OtherSTATE OF MISSOURI
1-10-7418OtherBEHAVIOR ANALYST CERTIFICATION BOARD