Provider Demographics
NPI:1417079872
Name:BEHAVIORAL MEDICINE CONSULTING, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE CONSULTING, INC.
Other - Org Name:LAKE CITIES FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:940-595-9152
Mailing Address - Street 1:1406 N CORINTH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5448
Mailing Address - Country:US
Mailing Address - Phone:940-595-9152
Mailing Address - Fax:940-497-9153
Practice Address - Street 1:1406 N CORINTH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5448
Practice Address - Country:US
Practice Address - Phone:940-595-9152
Practice Address - Fax:940-497-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-0747103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18MAMedicare UPIN