Healthcare Provider Details

I. General information

NPI: 1619680535
Provider Name (Legal Business Name): KEY AUTISM SERVICES MO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHESTERFIELD BUSINESS PKWY FL 2
CHESTERFIELD MO
63005-1271
US

IV. Provider business mailing address

106 APPLE ST STE 221
TINTON FALLS NJ
07724-2670
US

V. Phone/Fax

Practice location:
  • Phone: 857-829-4040
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK HARPER
Title or Position: CEO
Credential:
Phone: 857-829-4040