NPI 1093250060 · live from the CMS NPI Registry
Mountain State Applied Behavior Analysis LLC
Behavior Analyst in Martinsburg, WV. National Provider Identifier 1093250060, active.
NPI record
| NPI | 1093250060 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 1010 Winchester Ave, Martinsburg, WV 25401 |
| Practice phone | 304-290-4262 |
| Mailing address | Po Box 442, Shepherdstown, WV 25443 |
| Enumerated | December 30, 2016 |
| Last updated | January 4, 2022 |
| Authorized official | Ezra Hall, Owner |
| Other names | Mountain State Aba |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst primary | 103K00000X | 1-14-16309 (WV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.