Provider Demographics
NPI:1669481495
Name:BEHAVIOR MANAGEMENT PC INC
Entity Type:Organization
Organization Name:BEHAVIOR MANAGEMENT PC INC
Other - Org Name:BEHAVIOR MANAGEMENT ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-782-1910
Mailing Address - Street 1:2702 CUNNINGHAM AVE
Mailing Address - Street 2:STE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1570
Mailing Address - Country:US
Mailing Address - Phone:417-782-1910
Mailing Address - Fax:417-782-1844
Practice Address - Street 1:2702 CUNNINGHAM AVE
Practice Address - Street 2:STE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1570
Practice Address - Country:US
Practice Address - Phone:417-782-1910
Practice Address - Fax:417-782-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505993709Medicaid
OK100713230AMedicaid
KS200671810AMedicaid
MO000013574Medicare ID - Type Unspecified