MEDICARE: NATIONAL MENTOR SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1235775248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MENTOR SERVICES, LLC

Provider Business Mailing Address
First Line	:	6067 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1648
Country	:	US
Telephone Number	:	636-685-0804
Fax Number	:	636-685-0805

Provider Business Practice Location Address
First Line	:	11872 WESTLINE INDUSTRIAL DR STE 180
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3331
Country	:	US
Telephone Number	:	314-991-7944
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	MORGAN KEENCE
Credential	:
Telephone Number	:	314-991-7944

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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