Provider Demographics
NPI:1710559349
Name:BIRKETT BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:BIRKETT BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-414-9329
Mailing Address - Street 1:1301 10TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2552
Mailing Address - Country:US
Mailing Address - Phone:641-414-9329
Mailing Address - Fax:
Practice Address - Street 1:1301 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2552
Practice Address - Country:US
Practice Address - Phone:641-414-9329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)