Provider Demographics
NPI:1366817793
Name:EXCEPTIONAL LEARNERS BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:EXCEPTIONAL LEARNERS BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:720-331-1419
Mailing Address - Street 1:PO BOX 3476
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063-3476
Mailing Address - Country:US
Mailing Address - Phone:720-331-1419
Mailing Address - Fax:
Practice Address - Street 1:18687 W 165TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:720-331-1419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-08-4710103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201113520AMedicaid
1104140284OtherTYPE 1 NPI