Healthcare Provider Details

I. General information

NPI: 1699087122
Provider Name (Legal Business Name): BEHAVIORAL CONSULTING SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 OAKFIELD AVE
DIX HILLS NY
11746-6305
US

IV. Provider business mailing address

188 OAKFIELD AVE
DIX HILLS NY
11746-6305
US

V. Phone/Fax

Practice location:
  • Phone: 631-940-1156
  • Fax:
Mailing address:
  • Phone: 631-940-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JAMES ANTHONY WALLACE
Title or Position: BUSINESS MANAGER
Credential: B.B.A.
Phone: 631-940-1156