Provider Demographics
NPI:1265744700
Name:BEHAVIORAL HEALTH ASSOCIATES, INC.
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEISTNER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-325-6590
Mailing Address - Street 1:1367 E LAFAYETTE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4774
Mailing Address - Country:US
Mailing Address - Phone:850-325-6590
Mailing Address - Fax:850-325-6591
Practice Address - Street 1:1367 E LAFAYETTE ST
Practice Address - Street 2:SUITE B
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4774
Practice Address - Country:US
Practice Address - Phone:850-325-6590
Practice Address - Fax:850-325-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1654742363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty