Individual
KATIE MARIE PHIPPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2240 COUNTY ROAD 1270, WILLOW SPRINGS, MO 65793-3393
(573) 883-6761
(417) 815-9405
Mailing address
PO BOX 683, WILLOW SPRINGS, MO 65793-0683
(573) 883-6761
(417) 815-9405
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2023002798
MO
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
730122799
—
MO
01
—
RBT-19-91402
REGISTERED BEHAVIOR TECHNICIAN
CO
Enumeration date
12/03/2019
Last updated
05/04/2023
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