Provider Demographics
NPI:1477923811
Name:KEYSTONE AUTISM AND BEHAVIOR INTERVENTIONS LLC
Entity Type:Organization
Organization Name:KEYSTONE AUTISM AND BEHAVIOR INTERVENTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANDRA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-532-6267
Mailing Address - Street 1:125 WATKINS RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-1056
Mailing Address - Country:US
Mailing Address - Phone:937-532-6267
Mailing Address - Fax:937-625-4357
Practice Address - Street 1:125 WATKINS RD
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1056
Practice Address - Country:US
Practice Address - Phone:937-532-6267
Practice Address - Fax:937-625-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA 162103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty