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General NPI Number Information
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NPI Number | 1578890869
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Entity Type | Organization
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Legal Business Name | TRUMAN STATE UNIVERSITY
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 606 S HALLIBURTON ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-3712
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Country | US
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Telephone | 660-785-7551
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Fax | 660-785-7632
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Provider Business Mailing Address
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Address Line | 606 S HALLIBURTON ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-3712
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Country | US
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Telephone | 660-785-7551
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Fax | 660-785-7632
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARYELLEN KOCH JENSEN
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Credential | BCBA, LBA
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Telephone | 660-341-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 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 #3
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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 #4
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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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