Provider Demographics
NPI:1013982354
Name:BEHAVIORAL MEDICINE CENTER
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUPURDIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-747-2215
Mailing Address - Street 1:421 W RIVERSIDE AVE
Mailing Address - Street 2:STE 972
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0405
Mailing Address - Country:US
Mailing Address - Phone:509-747-2215
Mailing Address - Fax:509-747-2217
Practice Address - Street 1:421 W RIVERSIDE AVE
Practice Address - Street 2:STE 972
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0405
Practice Address - Country:US
Practice Address - Phone:509-747-2215
Practice Address - Fax:509-747-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty