Healthcare Provider Details

I. General information

NPI: 1104168210
Provider Name (Legal Business Name): BEHAVIOR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 WATHENS XING STE 104
OWENSBORO KY
42301
US

IV. Provider business mailing address

3445 WATHENS XING STE 104
OWENSBORO KY
42301-7009
US

V. Phone/Fax

Practice location:
  • Phone: 270-686-3999
  • Fax: 270-686-3926
Mailing address:
  • Phone: 270-686-3999
  • Fax: 270-686-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY BITTMAN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 270-686-3999