Individual
ALICE MARIE BLYTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, BCBA, LBA
Contact information
Practice address
3403 N BELTON AVE, RIVERSIDE, MO 64150-9502
(816) 863-4542
Mailing address
3403 N BELTON AVE, RIVERSIDE, MO 64150-9502
(816) 863-4542
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2010007552
MO
103K00000X
Behavior Analyst
Primary
2012010600
MO
Other
Enumeration date
04/15/2012
Last updated
04/15/2012
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