Provider Demographics
NPI:1912695073
Name:MADISON BEHAVIORAL HEALTH CONSULTANTS
Entity Type:Organization
Organization Name:MADISON BEHAVIORAL HEALTH CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-318-3639
Mailing Address - Street 1:PO BOX 5155
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-0155
Mailing Address - Country:US
Mailing Address - Phone:608-318-3639
Mailing Address - Fax:
Practice Address - Street 1:2926 BLUFF ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3421
Practice Address - Country:US
Practice Address - Phone:608-318-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health