Healthcare Provider Details

I. General information

NPI: 1821234055
Provider Name (Legal Business Name): BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAIN ST N
HAZLETON IA
50641-7701
US

IV. Provider business mailing address

105 MAIN ST N PO BOX 74
HAZLETON IA
50641-7701
US

V. Phone/Fax

Practice location:
  • Phone: 319-636-2100
  • Fax: 319-636-2022
Mailing address:
  • Phone: 319-636-2100
  • Fax: 319-636-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1325
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. KIMBERLY MARIE GAMM
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LBSW, ACADC
Phone: 319-636-2100