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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
103TC1900X
Counseling Psychologist
106E00000X
Assistant Behavior Analyst
106S00000X
Behavior Technician
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other

Enumeration date
11/09/2009
Last updated
03/26/2026
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