Provider Demographics
NPI:1619134137
Name:NEW BEHAVIORAL MEDICINE LLC
Entity Type:Organization
Organization Name:NEW BEHAVIORAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-996-1345
Mailing Address - Street 1:200 E WASHINGTON ST
Mailing Address - Street 2:P O BOX 8031
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5490
Mailing Address - Country:US
Mailing Address - Phone:920-996-1345
Mailing Address - Fax:920-739-0124
Practice Address - Street 1:200 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5490
Practice Address - Country:US
Practice Address - Phone:920-996-1345
Practice Address - Fax:920-739-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty