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General NPI Number Information
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NPI Number | 1003775313
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Entity Type | Organization
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Legal Business Name | ABA SUPPORTIVE CARE MO LLC
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 218 S MAIN ST FL 2
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City | JOPLIN
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State | MO
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Zip | 64801-2308
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Country | US
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Telephone | 317-936-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 218 S MAIN ST FL 2
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City | JOPLIN
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State | MO
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Zip | 64801-2308
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Country | US
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Telephone |
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Fax | 317-936-1241
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Authorized Official
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Title or Position | MEMBER
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Name | RUBEN KESHERIM
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Credential |
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Telephone | 317-936-1240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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