Provider Demographics
NPI:1811077753
Name:BEHAVIORAL HEALTH CENTER OF EXCELLENCE, LLC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH CENTER OF EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BALERIA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC, CNS, RXN
Authorized Official - Phone:719-226-0659
Mailing Address - Street 1:2212 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3325
Mailing Address - Country:US
Mailing Address - Phone:719-226-0659
Mailing Address - Fax:719-226-0753
Practice Address - Street 1:2212 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3325
Practice Address - Country:US
Practice Address - Phone:719-226-0659
Practice Address - Fax:719-226-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81050163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty