Provider Demographics
NPI:1902015308
Name:CENTER FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CENTER FOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-261-1571
Mailing Address - Street 1:2336 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4343
Mailing Address - Country:US
Mailing Address - Phone:651-261-6571
Mailing Address - Fax:651-765-4307
Practice Address - Street 1:2336 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4343
Practice Address - Country:US
Practice Address - Phone:651-261-6571
Practice Address - Fax:651-765-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0134103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty