Provider Demographics
NPI:1073965539
Name:LIFELONG EXCEPTIONAL AUTISM PROGRAMS LLC
Entity Type:Organization
Organization Name:LIFELONG EXCEPTIONAL AUTISM PROGRAMS LLC
Other - Org Name:LEAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:816-873-5327
Mailing Address - Street 1:PO BOX 13264
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66282-3264
Mailing Address - Country:US
Mailing Address - Phone:816-873-5327
Mailing Address - Fax:
Practice Address - Street 1:9900 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4134
Practice Address - Country:US
Practice Address - Phone:816-873-5327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015001981103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty