Provider Demographics
NPI:1821494584
Name:AGAPI BEHAVIORAL CONSULTANTS
Entity Type:Organization
Organization Name:AGAPI BEHAVIORAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURRET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-409-6990
Mailing Address - Street 1:7 MCKENNA COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2633
Mailing Address - Country:US
Mailing Address - Phone:864-509-1555
Mailing Address - Fax:
Practice Address - Street 1:7 MCKENNA COMMONS CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2633
Practice Address - Country:US
Practice Address - Phone:864-509-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7752Medicaid