Provider Demographics
NPI:1023569340
Name:BHG - BEHAVIORAL HEALTH GROUP
Entity Type:Organization
Organization Name:BHG - BEHAVIORAL HEALTH GROUP
Other - Org Name:BHG - BEHAVIORAL HEALTH GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:469-801-3979
Mailing Address - Street 1:239 ACCESS RD
Mailing Address - Street 2:239 ACCESS ROAD
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-1682
Mailing Address - Country:US
Mailing Address - Phone:864-503-0207
Mailing Address - Fax:864-503-0807
Practice Address - Street 1:239 ACCESS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-1682
Practice Address - Country:US
Practice Address - Phone:864-503-0207
Practice Address - Fax:864-503-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization