Healthcare Provider Details

I. General information

NPI: 1558929539
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ADVOCACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PARK AVE S STE 3
SAINT CLOUD MN
56301-6196
US

IV. Provider business mailing address

PO BOX 7698
SAINT CLOUD MN
56302-7698
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-4571
  • Fax: 320-205-0930
Mailing address:
  • Phone: 320-251-4571
  • Fax: 320-205-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN LUNDQUIST
Title or Position: BUSINESS MANAGER
Credential:
Phone: 320-251-4571