1144598244 NPI number — BEHAVIORAL MEDCINE CONSULTANTS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144598244 NPI number — BEHAVIORAL MEDCINE CONSULTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL MEDCINE CONSULTANTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144598244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4790 CAUGHLIN PKWY
Provider Second Line Business Mailing Address:
SUITE 173
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89519-0907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-828-2955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5421 KIETZKE LN
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89511-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-828-2955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEWANDOWSKI
Authorized Official First Name:
MICHALE
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
775-828-2955

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X , with the licence number:  PY 241 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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