Active NPI
Dylan Mason, PROVISIONAL BCABA
- Behavior Analyst
- Kirkwood, MO
National Provider Identifier
1043091150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 2023041335
- Practice address
- 338 S Kirkwood Rd Ste 103
Kirkwood, MO 63122-6166 - Phone
- (314) 806-0735
- NPI assigned
- Oct 13, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 2023041335 | MO | Primary |
Addresses
Primary practice location
338 S Kirkwood Rd Ste 103
Kirkwood, MO 63122-6166
Mailing address
338 S Kirkwood Rd Ste 103
Kirkwood, MO 63122-6166
Phone (314) 806-0735
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2023041335 | MO | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697155200000",
"number": "1043091150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "338 S KIRKWOOD RD STE 103",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226166",
"telephone_number": "314-806-0735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "338 S KIRKWOOD RD STE 103",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631226166",
"telephone_number": "314-806-0735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASON",
"first_name": "DYLAN",
"credential": "PROVISIONAL BCABA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-13",
"last_updated": "2023-10-13",
"certification_date": "2023-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MO",
"license": "2023041335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.