Individual
MRS. SHELLEY LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. ED. BCBA
Contact information
Practice address
7741 GANNON AVE, SAINT LOUIS, MO 63130-2822
(314) 725-9078
Mailing address
7741 GANNON AVE, SAINT LOUIS, MO 63130-2822
(314) 725-9078
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
1-03-1348
MO
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
1-03-1348
MO
Other
Enumeration date
02/25/2008
Last updated
02/25/2008
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