Healthcare Provider Details

I. General information

NPI: 1619062676
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ALTERNATIVES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 E FERGUSON AVE
WOOD RIVER IL
62095-2003
US

IV. Provider business mailing address

337 E FERGUSON AVE
WOOD RIVER IL
62095-2003
US

V. Phone/Fax

Practice location:
  • Phone: 618-251-4073
  • Fax: 618-251-6246
Mailing address:
  • Phone: 618-251-4073
  • Fax: 618-251-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BELINDA L. GUNNING
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 618-251-4073