Provider Demographics
NPI:1740370089
Name:BEHAVIORAL MEDICINE ASSOCIATES OF MID MICHIGAN PC
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES OF MID MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:989-832-9161
Mailing Address - Street 1:1205 E WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7035
Mailing Address - Country:US
Mailing Address - Phone:989-832-9161
Mailing Address - Fax:989-832-8813
Practice Address - Street 1:1205 E WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-7035
Practice Address - Country:US
Practice Address - Phone:989-832-9161
Practice Address - Fax:989-832-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P36530OtherMEDICARE PTAN