Healthcare Provider Details

I. General information

NPI: 1942709126
Provider Name (Legal Business Name): MONARCH BEHAVIORAL SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N 4TH ST
LEAVENWORTH KS
66048-1966
US

IV. Provider business mailing address

179 SW ROOSEVELT RDG
LEES SUMMIT MO
64081-4059
US

V. Phone/Fax

Practice location:
  • Phone: 913-250-5509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE GRIFFITH
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 913-250-5509