Provider Demographics
NPI:1649636952
Name:CADEUS BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:CADEUS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:PHD ABPP
Authorized Official - Phone:781-552-6500
Mailing Address - Street 1:4820 MORTENSEN RD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-5531
Mailing Address - Country:US
Mailing Address - Phone:781-552-6500
Mailing Address - Fax:
Practice Address - Street 1:4820 MORTENSEN RD.
Practice Address - Street 2:SUITE 102
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-5531
Practice Address - Country:US
Practice Address - Phone:781-552-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty