Provider Demographics
NPI:1770214223
Name:BHAKTI BEHAVIORAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:BHAKTI BEHAVIORAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/ MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-334-6879
Mailing Address - Street 1:27 JEMA CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4532
Mailing Address - Country:US
Mailing Address - Phone:678-334-6879
Mailing Address - Fax:
Practice Address - Street 1:10401 MONTGOMERY PKWY NE STE 1A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3876
Practice Address - Country:US
Practice Address - Phone:678-334-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty