Provider Demographics
NPI:1497965578
Name:BEHAVIORAL HEALTH SOLUTIONS P A
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH SOLUTIONS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:YAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-885-7376
Mailing Address - Street 1:OF PSYCHOLOGY AND COMMUNICATION STUDIES
Mailing Address - Street 2:UNIVERSITY OF IDAHO
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83844-3043
Mailing Address - Country:US
Mailing Address - Phone:208-885-7376
Mailing Address - Fax:
Practice Address - Street 1:OF PSYCHOLOGY AND COMMUNICATION STUDIES
Practice Address - Street 2:UNIVERSITY OF IDAHO
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-3043
Practice Address - Country:US
Practice Address - Phone:208-885-7376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3536101Y00000X
IDPSY-204103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8060033Medicaid
ID8060033Medicaid