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Individual

MS. THEA RAE ERVIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S. ABA, BCBA, LBA

Contact information

Practice address
12400 OLIVE BLVD STE 340, CREVE COEUR, MO 63141-5456
(314) 750-0068
Mailing address
416 N 23RD ST APT 513, SAINT LOUIS, MO 63103-1547
(270) 997-1470

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2016003795
MO

Other

Enumeration date
03/10/2016
Last updated
03/10/2016
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