Provider Demographics
NPI:1639254840
Name:PRIMARY BEHAVIORAL HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:PRIMARY BEHAVIORAL HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-378-2363
Mailing Address - Street 1:3433 BROADWAY ST NE STE 160
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1756
Mailing Address - Country:US
Mailing Address - Phone:612-378-2363
Mailing Address - Fax:612-378-2215
Practice Address - Street 1:3433 BROADWAY ST NE STE 160
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1756
Practice Address - Country:US
Practice Address - Phone:612-378-2363
Practice Address - Fax:612-378-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty