Individual provider Active NPI

Marcus Hibbard, BCBA

  • Behavior Analyst
  • Manchester, NH
National Provider Identifier
1356850770
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
2021047070 Issued in MO
Practice address
373 S Willow St Ste 266
Manchester, NH 03103-5751
Phone
(877) 315-8080
NPI assigned
Sep 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-17-27952 LA
Behavior Analyst 103K00000X 2021047070 MO Primary

Addresses

Primary practice location

373 S Willow St Ste 266
Manchester, NH 03103-5751

Mailing address

710 Clayworth Dr
Ballwin, MO 63011-3519
Phone (573) 201-3155

Other practice location 1

710 Clayworth Dr
Ballwin, MO 63011-3519
Phone (314) 390-6923

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

LicenseStateTypeSpecialty
2021047070MOMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Positive Reinforcement Behavior Therapy, Inc Behavior Analyst CurrentSince Jun 21, 2022 Accepting new patients
Therapy Dads, LLC Behavior Analyst CurrentSince Jun 21, 2022 Accepting new patients
Positive Reinforcement ABA Therapy Inc. Behavior Analyst PastSince Jun 21, 2022 Accepting new patients

Locations

2240 Bennington Pl
Maryland Heights, MO 63043
Phone (314) 390-6923

373 S Willow St
Ste 266
Manchester, NH 03103

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1356850770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 CLAYWORTH DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630113519",
            "telephone_number": "573-201-3155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "373 S WILLOW ST STE 266",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031035751",
            "telephone_number": "877-315-8080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 Clayworth Dr",
            "address_purpose": "LOCATION",
            "city": "Ballwin",
            "state": "MO",
            "postal_code": "630113519",
            "country_code": "US",
            "telephone_number": "314-390-6923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HIBBARD",
        "first_name": "MARCUS",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-28",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "LA",
            "license": "1-17-27952",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MO",
            "license": "2021047070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.