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Organization
TRUMAN STATE UNIVERSITY
Active
Organization
TRUMAN STATE UNIVERSITY
Active
Other names
Greenwood Interprofessional Autism Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARYELLEN KOCH JENSEN BCBA, LBA (DIRECTOR)
(660) 341-1105
Entity
Organization
Contact information
Practice address
606 S HALLIBURTON ST, KIRKSVILLE, MO 63501-3712
(660) 785-7551
(660) 785-7632
Mailing address
606 S HALLIBURTON ST, KIRKSVILLE, MO 63501-3712
(660) 785-7551
(660) 785-7632
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
NULL
103K00000X
Behavior Analyst
Primary
—
—
103TC1900X
Counseling Psychologist
—
NULL
103TC1900X
Counseling Psychologist
—
—
106E00000X
Assistant Behavior Analyst
—
NULL
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
NULL
106S00000X
Behavior Technician
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
Other
Enumeration date
11/09/2009
Last updated
03/26/2026
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