Provider Demographics
NPI:1982291365
Name:PINNACLE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:PINNACLE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GAIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-784-7270
Mailing Address - Street 1:520 STOKES RD STE B1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2915
Mailing Address - Country:US
Mailing Address - Phone:813-784-7270
Mailing Address - Fax:
Practice Address - Street 1:520 STOKES RD STE B1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2915
Practice Address - Country:US
Practice Address - Phone:813-784-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)