NPIMap

Organization Active NPI

Mountain State Applied Behavior Analysis LLC

Doing business as Mountain State ABA

  • Behavior Analyst
  • Martinsburg, WV
National Provider Identifier
1093250060
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-14-16309 Issued in WV
Legal business name
MOUNTAIN STATE APPLIED BEHAVIOR ANALYSIS LLC
Doing business as
Mountain State ABA
Practice address
1010 Winchester Ave
Martinsburg, WV 25401-1683
Phone
(304) 290-4262
Fax
(304) 212-0627
NPI assigned
Dec 30, 2016
Last updated
Jan 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ezra HallNPI 1265848451
Title
Owner
Phone
(304) 290-4262

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-14-16309 WV Primary

Addresses

Primary practice location

1010 Winchester Ave
Martinsburg, WV 25401-1683

Mailing address

PO Box 442
Shepherdstown, WV 25443-0442
Phone (304) 290-4262

Other names 1

  • Mountain State ABA Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1093250060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 442",
            "city": "SHEPHERDSTOWN",
            "state": "WV",
            "postal_code": "254430442",
            "telephone_number": "304-290-4262",
            "fax_number": "304-212-0627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 WINCHESTER AVE",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254011683",
            "telephone_number": "304-290-4262",
            "fax_number": "304-212-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE APPLIED BEHAVIOR ANALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-30",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "EZRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-290-4262"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WV",
            "license": "1-14-16309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain State ABA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain State ABA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.