Provider Demographics
NPI:1922041136
Name:BEHAVIORAL HEALTH MANAGEMENT GROUP, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH MANAGEMENT GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:304-232-7232
Mailing Address - Street 1:1025 MAIN ST
Mailing Address - Street 2:SUITE 708 MULL CENTER
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2726
Mailing Address - Country:US
Mailing Address - Phone:304-232-7232
Mailing Address - Fax:304-232-7245
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:SUITE 708 MULL CENTER
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2726
Practice Address - Country:US
Practice Address - Phone:304-232-7232
Practice Address - Fax:304-232-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1697101Y00000X
WV1683101YM0800X
WV313103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01265425000Medicaid
WV01265425000Medicaid