Provider Demographics
NPI:1366281883
Name:AMO, ELISE G (BCBA-LBA)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:G
Last Name:AMO
Suffix:
Gender:F
Credentials:BCBA-LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1078 HEADQUARTERS PARK DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-1910
Mailing Address - Country:US
Mailing Address - Phone:636-405-2701
Mailing Address - Fax:636-422-1223
Practice Address - Street 1:1078 HEADQUARTERS PARK DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-1910
Practice Address - Country:US
Practice Address - Phone:636-405-2701
Practice Address - Fax:636-422-1223
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023014031103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst