MEDICARE: B/G BEHAVIORAL HEALTH SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	MD055893L	PA
2	2084P0800X	Psychiatry Physician	MD055893L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124009519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B/G BEHAVIORAL HEALTH SERVICES PC

Provider Business Mailing Address
First Line	:	2345 MURRAY AVE
Second Line	:	SUITE 200
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-2352
Country	:	US
Telephone Number	:	412-421-6770
Fax Number	:	412-421-6596

Provider Business Practice Location Address
First Line	:	1910 COCHRAN RD
Second Line	:	ONE MANOR OAK, SUITE 600
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-1203
Country	:	US
Telephone Number	:	412-563-8800
Fax Number	:	412-563-8319

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN GUTERSON
Credential	:	MD
Telephone Number	:	412-421-6770

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	06/18/2008

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