Provider Demographics
NPI:1588038079
Name:CONNECT BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:CONNECT BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:URDA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:540-287-2568
Mailing Address - Street 1:90 TWELVE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-5633
Mailing Address - Country:US
Mailing Address - Phone:888-789-5373
Mailing Address - Fax:877-663-1515
Practice Address - Street 1:90 TWELVE OAKS DR
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-5633
Practice Address - Country:US
Practice Address - Phone:888-789-5373
Practice Address - Fax:877-663-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017601710002Medicaid