Provider Demographics
NPI:1821234055
Name:BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LBSW, ACADC
Authorized Official - Phone:319-636-2100
Mailing Address - Street 1:105 MAIN ST N
Mailing Address - Street 2:PO BOX 74
Mailing Address - City:HAZLETON
Mailing Address - State:IA
Mailing Address - Zip Code:50641-7701
Mailing Address - Country:US
Mailing Address - Phone:319-636-2100
Mailing Address - Fax:319-636-2022
Practice Address - Street 1:105 MAIN ST N
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:IA
Practice Address - Zip Code:50641-7701
Practice Address - Country:US
Practice Address - Phone:319-636-2100
Practice Address - Fax:319-636-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1325251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health