Provider Demographics
NPI:1750416509
Name:BEHAVIOR MEDICINE ASSOCIATES, INC.
Entity type:Organization
Organization Name:BEHAVIOR MEDICINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-261-1216
Mailing Address - Street 1:3806 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3527
Mailing Address - Country:US
Mailing Address - Phone:614-261-1216
Mailing Address - Fax:614-263-7070
Practice Address - Street 1:3806 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3527
Practice Address - Country:US
Practice Address - Phone:614-261-1216
Practice Address - Fax:614-263-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1180103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY NO.
570-74-9444OtherSOCIAL SECURITY NO.