Provider Demographics
NPI:1760549893
Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:952-844-0619
Mailing Address - Street 1:3300 EDINBOROUGH WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5923
Mailing Address - Country:US
Mailing Address - Phone:952-844-0619
Mailing Address - Fax:952-844-0628
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5923
Practice Address - Country:US
Practice Address - Phone:952-844-0619
Practice Address - Fax:952-844-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4K592BEOtherBCBSMN GROUP #