Project Odyssey Aba, Llc | |
815 Gass Ave Belleville IL 62220-2303 | |
(337) 602-8884 | |
(618) 418-4422 |
Full Name | Project Odyssey Aba, Llc |
---|---|
Speciality | Behavior Analyst |
Location | 815 Gass Ave, Belleville, Illinois |
Authorized Official Name and Position | Dominique Rougeau (OWNER/BEHAVIOR ANALYST) |
Authorized Official Contact | 3372925906 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Project Odyssey Aba, Llc 815 Gass Ave Belleville IL 62220-2303 Ph: (337) 602-8884 | Project Odyssey Aba, Llc 815 Gass Ave Belleville IL 62220-2303 Ph: (337) 602-8884 |
NPI Number | 1114688660 |
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Provider Enumeration Date | 01/06/2022 |
Last Update Date | 01/13/2022 |
Certification Date | 01/13/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114688660 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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