Provider Demographics
NPI:1659326130
Name:BEHAVIORAL HEALTH MANAGEMENT SERVICES, INC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH MANAGEMENT SERVICES, INC
Other - Org Name:BAYCARE LIFE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/FINANCIAL SVCS
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-852-3304
Mailing Address - Street 1:PO BOX 403974
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3974
Mailing Address - Country:US
Mailing Address - Phone:813-852-3272
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 640
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-872-7582
Practice Address - Fax:813-635-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267725300Medicaid
FLX1238AMedicare PIN