Provider Demographics
NPI:1265532600
Name:BLUESTEM BEHAVIORAL HEALTH GROUP LLC
Entity type:Organization
Organization Name:BLUESTEM BEHAVIORAL HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:724-774-1404
Mailing Address - Street 1:336 COLLEGE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2231
Mailing Address - Country:US
Mailing Address - Phone:724-774-1404
Mailing Address - Fax:
Practice Address - Street 1:336 COLLEGE AVE STE 104
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2231
Practice Address - Country:US
Practice Address - Phone:724-774-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1454844OtherPA BS
PA1454844OtherPA BS