Provider Demographics
NPI:1093412579
Name:BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN BCC
Authorized Official - Phone:971-208-4663
Mailing Address - Street 1:1230 WESTWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3749
Mailing Address - Country:US
Mailing Address - Phone:971-208-4663
Mailing Address - Fax:
Practice Address - Street 1:1230 WESTWOOD DR NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3749
Practice Address - Country:US
Practice Address - Phone:971-208-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty