Provider Demographics
NPI:1770801342
Name:KEN NELSON BEHAVIOR SERVICES
Entity type:Organization
Organization Name:KEN NELSON BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, LCSW, BCBA
Authorized Official - Phone:812-453-5927
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47665-0822
Mailing Address - Country:US
Mailing Address - Phone:812-453-5927
Mailing Address - Fax:
Practice Address - Street 1:508 E WARRICK ST.
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47665
Practice Address - Country:US
Practice Address - Phone:812-453-5927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IN35000054A106H00000X
IN34003111A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty