Individual
MATTHEW GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
12110 CLAYTON RD, SAINT LOUIS, MO 63131-2599
(314) 989-8150
Mailing address
12110 CLAYTON RD, SAINT LOUIS, MO 63131-2599
(314) 989-8150
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2018021548
MO
Other
Enumeration date
01/06/2021
Last updated
01/06/2021
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