Provider Demographics
NPI:1902143282
Name:MOMENTUM BEHAVIORAL HEALTH ASSOCIATES, INC
Entity Type:Organization
Organization Name:MOMENTUM BEHAVIORAL HEALTH ASSOCIATES, INC
Other - Org Name:MOMENTUM BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:816-457-3899
Mailing Address - Street 1:705B SE MELODY LN
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4380
Mailing Address - Country:US
Mailing Address - Phone:816-457-3899
Mailing Address - Fax:888-482-2151
Practice Address - Street 1:705B SE MELODY LN
Practice Address - Street 2:SUITE 112
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4380
Practice Address - Country:US
Practice Address - Phone:816-457-3899
Practice Address - Fax:888-482-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011003585103K00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty