Provider Demographics
NPI:1356643969
Name:BEHAVIORAL CLINICAL SERVICES
Entity Type:Organization
Organization Name:BEHAVIORAL CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WITHROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-6500
Mailing Address - Street 1:1005 N 12TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3156
Mailing Address - Country:US
Mailing Address - Phone:970-241-6500
Mailing Address - Fax:970-243-8835
Practice Address - Street 1:1005 N 12TH ST STE 105
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3156
Practice Address - Country:US
Practice Address - Phone:970-241-6500
Practice Address - Fax:970-243-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801557OtherMEDICARE PROVIDER #C801557