Provider Demographics
NPI:1558676239
Name:BEHAVIORAL MENTAL HEALTH SERVICES, PC
Entity Type:Organization
Organization Name:BEHAVIORAL MENTAL HEALTH SERVICES, PC
Other - Org Name:COMPREHENSIVE TREATMENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FREESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY, D LCSW
Authorized Official - Phone:435-787-2272
Mailing Address - Street 1:40 W CACHE VALLEY BLVD STE 10A
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-8450
Mailing Address - Country:US
Mailing Address - Phone:435-787-2272
Mailing Address - Fax:435-713-4001
Practice Address - Street 1:40 W CACHE VALLEY BLVD STE 10A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-8450
Practice Address - Country:US
Practice Address - Phone:435-787-2272
Practice Address - Fax:435-713-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15984251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health