Provider Demographics
NPI:1649413006
Name:ADVANCED BEHAVIORAL SYSTEMS
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL SYSTEMS
Other - Org Name:ENGAGE BEHAVIORAL HEALTH, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-584-2604
Mailing Address - Street 1:PO BOX 631270
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1270
Mailing Address - Country:US
Mailing Address - Phone:877-350-5005
Mailing Address - Fax:847-584-2604
Practice Address - Street 1:9051 FLORIDA MINING BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1240
Practice Address - Country:US
Practice Address - Phone:877-350-5005
Practice Address - Fax:847-584-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 103K00000X
FL1-03-1244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty