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KEYSTONE BEHAVIORAL CONSULTATION LLC
Complete NPI Record 1467237008
Behavior Analyst in Montrose, CO

NPI Status: Active since August 30, 2023

Contact Information

1848 E. MAIN ST.
MONTROSE, CO
ZIP 81401
Phone: (970) 765-0550
Fax: (970) 363-8597

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Business Practice Location Address Fax Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Authorized Official Last Name
  21. Authorized Official First Name
  22. Authorized Official Title or Position
  23. Authorized Official Telephone Number
  24. Healthcare Provider Taxonomy Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Is Organization Subpart
  27. Authorized Official Credential Text
  28. Healthcare Provider Taxonomy Group 1
  29. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1467237008. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1467237008
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Entity Type Code: 2
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 12743 5875 RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: MONTROSE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CO
The country code in the location address of the provider being identified.
Provider Business Mailing Address Postal Code: 814038393
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 9707655284
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 1848 E. MAIN ST.
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MONTROSE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CO
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 81401
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9707650550
The city name in the mailing address of the provider being identified.
Provider Business Practice Location Address Fax Number: 9703638597
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Enumeration Date: 8/30/2023
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/12/2024
Authorized Official Last Name: BURNETT
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MALLORI
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Authorized Official Title or Position: EXECUTIVE DIRECTOR
The title or position of the authorized official.
Authorized Official Telephone Number: 9707655284
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 103K00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Credential Text: BCBA
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 2/9/2024