Provider Demographics
NPI:1629563853
Name:DR BEHAVIORAL MEDICINE SERVICES
Entity type:Organization
Organization Name:DR BEHAVIORAL MEDICINE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-201-6424
Mailing Address - Street 1:8100 E 22ND ST N STE 1600-B
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2321
Mailing Address - Country:US
Mailing Address - Phone:316-201-6424
Mailing Address - Fax:316-201-6428
Practice Address - Street 1:8100 E 22ND ST N STE 1600-B
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2321
Practice Address - Country:US
Practice Address - Phone:316-201-6424
Practice Address - Fax:316-201-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)