Healthcare Provider Details

I. General information

NPI: 1962561654
Provider Name (Legal Business Name): BEHAVIORAL SUPPORT SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S. WALNUT ST. SUITE 309-11
MUNCIE IN
47305
US

IV. Provider business mailing address

405 S. WALNUT ST. SUITE 309-11
MUNCIE IN
47305
US

V. Phone/Fax

Practice location:
  • Phone: 765-286-8266
  • Fax: 765-287-8842
Mailing address:
  • Phone: 765-286-8266
  • Fax: 765-287-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN DOUGLAS THOMASON
Title or Position: OWNER
Credential: M.A.
Phone: 765-286-8266