Provider Demographics
NPI:1548213085
Name:BEHAVIORAL MEDICINE & NEUROPSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE & NEUROPSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:KINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-397-2224
Mailing Address - Street 1:6973 REDANSA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1201
Mailing Address - Country:US
Mailing Address - Phone:815-397-2224
Mailing Address - Fax:
Practice Address - Street 1:6973 REDANSA DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1201
Practice Address - Country:US
Practice Address - Phone:815-397-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:2006-05-18
Deactivation Code:
Reactivation Date:2006-07-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL104268OtherHEALTH ALLIANCE
IL10132032OtherBLUE CROSS BLUE SHIELD