MEDICARE: MORGAN KEENCE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-13-15051	MO

General Provider Information

NPI Number	:	1114317500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN KEENCE BCBA

Provider Business Mailing Address
First Line	:	11 LAKE PARK CT
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-3220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11872 WESTLINE INDUSTRIAL DR STE 180
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3331
Country	:	US
Telephone Number	:	314-991-7944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	09/17/2019

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