Organization
SOUTHEAST BEHAVIOR INTERVENTION & CONSULTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE SUZANNE BRAZER BCABA, LABA (ASSISTANT BEHAVIOR ANALYST)
(573) 225-5828
Entity
Organization
Contact information
Practice address
373 RYLANE, JACKSON, MO 63755-8730
(573) 225-5828
Mailing address
373 RYLANE, JACKSON, MO 63755-8730
(573) 225-5828
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
730026462
—
MO
Enumeration date
07/01/2019
Last updated
07/01/2019
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