Healthcare Provider Details

I. General information

NPI: 1245550250
Provider Name (Legal Business Name): BEHAVIORAL CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11206 WOODTOWN RD
GALENA OH
43021-9638
US

IV. Provider business mailing address

11206 WOODTOWN RD
GALENA OH
43021-9638
US

V. Phone/Fax

Practice location:
  • Phone: 614-923-2585
  • Fax: 614-923-2585
Mailing address:
  • Phone: 614-923-2585
  • Fax: 614-923-2585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6606
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number6606
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6606
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6606
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT DALTON
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 614-975-1675