Provider Demographics
NPI:1326423781
Name:BEHAVIORAL MEDICINE LLC
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEACHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-272-3889
Mailing Address - Street 1:8104 SEATON PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7204
Mailing Address - Country:US
Mailing Address - Phone:334-272-3889
Mailing Address - Fax:334-272-4089
Practice Address - Street 1:8104 SEATON PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116
Practice Address - Country:US
Practice Address - Phone:334-272-3889
Practice Address - Fax:334-272-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL179762Medicaid