Provider Demographics
NPI:1700405461
Name:KEYSTONE BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:KEYSTONE BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISHBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:570-852-9217
Mailing Address - Street 1:334 HIGHLARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1656
Mailing Address - Country:US
Mailing Address - Phone:570-852-9217
Mailing Address - Fax:
Practice Address - Street 1:310 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5442
Practice Address - Country:US
Practice Address - Phone:570-362-2348
Practice Address - Fax:570-565-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health