Provider Demographics
NPI:1366536120
Name:ALLIED BEHAVIORAL CONSULTANTS, INC.
Entity type:Organization
Organization Name:ALLIED BEHAVIORAL CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHDIECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-567-5000
Mailing Address - Street 1:11477 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7130
Mailing Address - Country:US
Mailing Address - Phone:314-567-5000
Mailing Address - Fax:314-567-3110
Practice Address - Street 1:11477 OLDE CABIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7130
Practice Address - Country:US
Practice Address - Phone:314-567-5000
Practice Address - Fax:314-567-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001052Medicare ID - Type Unspecified