Provider Demographics
NPI:1346376282
Name:COMPREHENSIVE BEHAVIORAL HEALTH SERVICES, PA
Entity Type:Organization
Organization Name:COMPREHENSIVE BEHAVIORAL HEALTH SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-388-0052
Mailing Address - Street 1:2835 S SERVICE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1883
Mailing Address - Country:US
Mailing Address - Phone:651-388-0052
Mailing Address - Fax:651-388-0054
Practice Address - Street 1:2835 S SERVICE DR STE 203
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1883
Practice Address - Country:US
Practice Address - Phone:651-388-0052
Practice Address - Fax:651-388-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4334103TC0700X
MNLP4533103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN43661Medicare UPIN
MNC04158Medicare ID - Type Unspecified