Provider Demographics
NPI:1295702694
Name:BEHAVIORAL SPECIALISTS INCORPORATED
Entity type:Organization
Organization Name:BEHAVIORAL SPECIALISTS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA MED
Authorized Official - Phone:570-524-0307
Mailing Address - Street 1:40 LAWTON LANE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847
Mailing Address - Country:US
Mailing Address - Phone:570-524-0307
Mailing Address - Fax:570-524-9973
Practice Address - Street 1:40 LAWTON LANE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847
Practice Address - Country:US
Practice Address - Phone:570-524-0307
Practice Address - Fax:570-524-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA308060251B00000X
PA305760251S00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health