Provider Demographics
NPI:1942623509
Name:BEHAVIORAL MEDICINE, P.C
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:KINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MS/LCPC
Authorized Official - Phone:815-520-5142
Mailing Address - Street 1:6973 REDANSA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1201
Mailing Address - Country:US
Mailing Address - Phone:815-397-2224
Mailing Address - Fax:815-397-2225
Practice Address - Street 1:6973 REDANSA DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1201
Practice Address - Country:US
Practice Address - Phone:815-397-2224
Practice Address - Fax:815-397-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty