ANGELA NICOLE MANGUM (NPI# 1821598293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821598293 |
| Entity Type | Individual |
| Full Name | ANGELA NICOLE MANGUM |
| Practice Address |
634 N Main St Ste 4 O Fallon IL 62269-3746 |
| Mailing Address |
21600 Oxnard St # Are1800 Woodland Hills CA 91367-4976 |
| Practice Telephone | 6187265870 |
| Mailing Telephone | 8183452345 |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2018-02-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103K00000X | Behavioral Analyst | M52501485731 | IL | Behavioral Health & Social Service Providers |
| Street Address |
634 N MAIN ST STE 4 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-3746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992210272 | Alexzandra Brawley | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2017-12-07 |
| 1841835733 | Candace Mary Amesquita | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-11-14 |
| 1831730266 | Taylor'jode Markeya Luster | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-10-07 |
| 1790336899 | Melissa Hug | Behavioral Analyst | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-09-20 |
| 1023668126 | Brandy L Wagner | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-09-19 |
| 1285283374 | Samantha C Eggemeyer | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-09-10 |
| 1164078531 | Jayda Celeste Cordell | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-08-12 |
| 1235785650 | Ashley Franklin | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-08-12 |
| 1073166138 | Mya Donai Thompson | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-07-18 |
| 1386204501 | Taylor Laing Barnes | Behavior Technician | 634 N Main St Ste 4, O Fallon, IL 62269-3746 | 2019-06-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 103K00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavioral Analyst |
| A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans. |
| Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114587284 | Makayla Baker | Behavioral Analyst | 1001 Still Water Dr, O Fallon, IL 62269-3482 | 2019-06-19 |
| 1477923365 | Kathleen Elizabeth Hodskins | Behavioral Analyst | 6 Eagle Ctr, O Fallon, IL 62269-1945 | 2015-10-05 |
| 1225479157 | Keely Deanna Lawler Sabaini | Behavioral Analyst | 418 E Adams St, O Fallon, IL 62269-1423 | 2013-07-08 |
| 1366059859 | Becky Furry | Behavioral Analyst | 6 Eagle Ctr Ste 1, O Fallon, IL 62269-1945 | 2020-09-28 |
| 1871100768 | Queen Marisha Liburd | Behavioral Analyst | 6 Eagle Ctr Ste 1, O Fallon, IL 62269-1945 | 2020-09-25 |
| 1033728167 | Alexandra Thompson | Behavioral Analyst | 145 Springfield Ct, O Fallon, IL 62269-2495 | 2020-07-24 |
| 1770108912 | Paige Alexandra Frick | Behavioral Analyst | 6 Eagle Ctr Ste 1, O Fallon, IL 62269-1945 | 2020-06-13 |
| 1578185237 | Porscha Williams | Behavioral Analyst | 6 Eagle Ctr Ste 1, O Fallon, IL 62269-1945 | 2020-05-15 |
| 1427670306 | Amanda Kay Boeckman | Behavioral Analyst | 6 Eagle Ctr Ste 1, O Fallon, IL 62269-1945 | 2020-05-13 |
| 1659918977 | Daniel Mikel Childress | Behavioral Analyst | 145 Springfield Ct, O Fallon, IL 62269-2495 | 2019-12-05 |
| Find all providers in O FALLON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.