Provider Demographics
NPI:1134121510
Name:BEHAVIORAL HEALTH CONSULTING GROUP, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH CONSULTING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-390-8903
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-0660
Mailing Address - Country:US
Mailing Address - Phone:440-230-5384
Mailing Address - Fax:
Practice Address - Street 1:4350 SIR ROBERT AVE
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4139
Practice Address - Country:US
Practice Address - Phone:440-390-8903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000296009OtherANTHEM BLUE SHIELD
OH2853318Medicaid
OH000000296009OtherANTHEM BLUE SHIELD
OH9336491Medicare ID - Type UnspecifiedMEDICARE