Provider Demographics
NPI:1497325138
Name:BEHAVIORAL AND INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:BEHAVIORAL AND INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-237-7174
Mailing Address - Street 1:313 SOUTH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-2162
Mailing Address - Country:US
Mailing Address - Phone:941-237-7174
Mailing Address - Fax:
Practice Address - Street 1:313 SOUTH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2162
Practice Address - Country:US
Practice Address - Phone:941-237-7174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013875200Medicaid
819448OtherBEACON
FL1126078OtherWELLCARE