Provider Demographics
NPI:1609017698
Name:BEHAVIORAL AND COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL AND COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EGAN
Authorized Official - Last Name:ROHR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:901-569-0165
Mailing Address - Street 1:550 LAZENBY DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-5030
Mailing Address - Country:US
Mailing Address - Phone:901-569-0165
Mailing Address - Fax:
Practice Address - Street 1:550 LAZENBY DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-5030
Practice Address - Country:US
Practice Address - Phone:901-569-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC #193101Y00000X
FLBACB #107103K00000X
TN#1424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5442100Medicaid