Provider Demographics
NPI:1417572413
Name:BIDWELL BEHAVIOR
Entity Type:Organization
Organization Name:BIDWELL BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:530-212-0205
Mailing Address - Street 1:3209 ESPLANADE STE 130
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0154
Mailing Address - Country:US
Mailing Address - Phone:530-208-5252
Mailing Address - Fax:530-965-5990
Practice Address - Street 1:3209 ESPLANADE STE 130
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0154
Practice Address - Country:US
Practice Address - Phone:530-208-5252
Practice Address - Fax:530-965-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty