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General NPI Number Information
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NPI Number | 1235775248
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Entity Type | Organization
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Legal Business Name | NATIONAL MENTOR SERVICES, LLC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 11872 WESTLINE INDUSTRIAL DR STE 180
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3331
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Country | US
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Telephone | 314-991-7944
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Fax |
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Provider Business Mailing Address
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Address Line | 6067 MEXICO RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-1648
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Country | US
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Telephone | 636-685-0804
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Fax | 636-685-0805
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Authorized Official
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Title or Position | BCBA
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Name | MORGAN KEENCE
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Credential |
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Telephone | 314-991-7944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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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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