Active NPI
Matthew Gillam, BCBA
- Behavior Analyst
- Saint Louis, MO
National Provider Identifier
1205424124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 2018021548
- Practice address
- 12110 Clayton Rd
Saint Louis, MO 63131-2599 - Phone
- (314) 989-8150
- NPI assigned
- Jan 6, 2021
- Sex
- Male
- Sole proprietor
- No
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 | 2018021548 | MO | Primary |
Addresses
Primary practice location
12110 Clayton Rd
Saint Louis, MO 63131-2599
Mailing address
12110 Clayton Rd
Saint Louis, MO 63131-2599
Phone (314) 989-8150
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 |
|---|---|---|---|
| 2018021548 | MO | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609891200000",
"number": "1205424124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12110 CLAYTON RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631312599",
"telephone_number": "314-989-8150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12110 CLAYTON RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631312599",
"telephone_number": "314-989-8150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLAM",
"first_name": "MATTHEW",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-06",
"last_updated": "2021-01-06",
"certification_date": "2021-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MO",
"license": "2018021548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.