Provider Demographics
NPI:1861817967
Name:AKTEP BEHAVIORAL LLC
Entity Type:Organization
Organization Name:AKTEP BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXUCITIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GILLINGHAM
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:609-915-7929
Mailing Address - Street 1:701 WORTHINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:609-915-7929
Mailing Address - Fax:
Practice Address - Street 1:701 WORTHINGTON DR.
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08085
Practice Address - Country:US
Practice Address - Phone:609-915-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty