Active NPI
Jessica Harralston
- Behavior Technician
- House Springs, MO
National Provider Identifier
1609368216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4400 Kennerly Park Rd
House Springs, MO 63051-4342 - Phone
- (636) 692-6831
- NPI assigned
- May 31, 2018
- Sex
- Female
- 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 Technician | 106S00000X | Primary |
Addresses
Primary practice location
4400 Kennerly Park Rd
House Springs, MO 63051-4342
Mailing address
1810 Craig Rd Ste 109
Saint Louis, MO 63146-4758
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Judevine, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Saint Louis, MO
- NPI 1518291418
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527724800000",
"number": "1609368216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1810 CRAIG RD STE 109",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631464758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4400 KENNERLY PARK RD",
"city": "HOUSE SPRINGS",
"state": "MO",
"postal_code": "630514342",
"telephone_number": "636-692-6831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRALSTON",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-31",
"last_updated": "2018-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in House Springs, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.