Provider Demographics
NPI:1750451746
Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-623-9322
Mailing Address - Street 1:601 W 2ND ST. STE 10
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201
Mailing Address - Country:US
Mailing Address - Phone:505-623-9322
Mailing Address - Fax:505-627-6339
Practice Address - Street 1:601 W 2ND ST STE 10
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4670
Practice Address - Country:US
Practice Address - Phone:505-623-9322
Practice Address - Fax:505-627-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0966103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty