Provider Demographics
NPI:1265047518
Name:TELEBEHAVIORAL MEDICINE ASSOCIATES INC.
Entity type:Organization
Organization Name:TELEBEHAVIORAL MEDICINE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-715-7391
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688-0522
Mailing Address - Country:US
Mailing Address - Phone:907-715-7391
Mailing Address - Fax:907-495-1283
Practice Address - Street 1:TELEBEHAVIORAL SERVICES
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:AK
Practice Address - Zip Code:99688-0522
Practice Address - Country:US
Practice Address - Phone:907-715-7391
Practice Address - Fax:907-495-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty