Provider Demographics
NPI:1992219588
Name:THE BEHAVIORAL HEALTH AND WELLNESS ACADEMY
Entity Type:Organization
Organization Name:THE BEHAVIORAL HEALTH AND WELLNESS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-810-1974
Mailing Address - Street 1:513 W CHOCOLATE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1632
Mailing Address - Country:US
Mailing Address - Phone:717-810-1974
Mailing Address - Fax:717-704-8476
Practice Address - Street 1:513 W CHOCOLATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-810-1974
Practice Address - Fax:717-704-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 103TC0700X, 104100000X, 1041C0700X, 106H00000X
PAPS017030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103493320Medicaid