Provider Demographics
NPI:1144598244
Name:BEHAVIORAL MEDCINE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL MEDCINE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHALE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-828-2955
Mailing Address - Street 1:4790 CAUGHLIN PKWY
Mailing Address - Street 2:SUITE 173
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0907
Mailing Address - Country:US
Mailing Address - Phone:775-828-2955
Mailing Address - Fax:
Practice Address - Street 1:5421 KIETZKE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3027
Practice Address - Country:US
Practice Address - Phone:775-828-2955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY 241103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty