Provider Demographics
NPI:1558696005
Name:BEHAVIORAL HEALTH THERAPIES INC.
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH THERAPIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-460-3934
Mailing Address - Street 1:40347 US HIGHWAY 19 N STE 103
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4841
Mailing Address - Country:US
Mailing Address - Phone:727-330-8932
Mailing Address - Fax:727-772-8212
Practice Address - Street 1:40347 US HIGHWAY 19 N STE 103
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4841
Practice Address - Country:US
Practice Address - Phone:727-330-8932
Practice Address - Fax:727-772-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL672227096Medicaid
FL002881000Medicaid
FL672227098Medicaid