Provider Demographics
NPI:1407109184
Name:J B BEHAVIORAL HEALTH AND CONSULTATION SERVICES PLLC
Entity Type:Organization
Organization Name:J B BEHAVIORAL HEALTH AND CONSULTATION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:248-761-9958
Mailing Address - Street 1:6688 NOLENSVILLE RD STE 111-131
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8833
Mailing Address - Country:US
Mailing Address - Phone:248-761-9958
Mailing Address - Fax:
Practice Address - Street 1:6688 NOLENSVILLE RD STE 111-131
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8833
Practice Address - Country:US
Practice Address - Phone:248-761-9958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty