Provider Demographics
NPI:1235775248
Name:NATIONAL MENTOR SERVICES, LLC
Entity Type:Organization
Organization Name:NATIONAL MENTOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-991-7944
Mailing Address - Street 1:6067 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1648
Mailing Address - Country:US
Mailing Address - Phone:636-685-0804
Mailing Address - Fax:636-685-0805
Practice Address - Street 1:11872 WESTLINE INDUSTRIAL DR STE 180
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3331
Practice Address - Country:US
Practice Address - Phone:314-991-7944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL MENTOR SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty