Provider Demographics
NPI:1225475130
Name:BEHAVIORAL INTELLIGENCE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL INTELLIGENCE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-846-5429
Mailing Address - Street 1:12059 BRIDLE POST PL
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5515
Mailing Address - Country:US
Mailing Address - Phone:540-846-5429
Mailing Address - Fax:
Practice Address - Street 1:9300 FOREST POINT CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4765
Practice Address - Country:US
Practice Address - Phone:540-846-5429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001517101YP2500X
VA07170000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty