Provider Demographics
NPI:1659821718
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, PT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORKEN
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:727-281-9202
Mailing Address - Street 1:3440 W DR MLK BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6223
Mailing Address - Country:US
Mailing Address - Phone:813-254-8055
Mailing Address - Fax:813-443-8163
Practice Address - Street 1:2995 DREW ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3012
Practice Address - Country:US
Practice Address - Phone:727-281-9065
Practice Address - Fax:813-635-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLPENDINGMedicaid