Healthcare Provider Details

I. General information

NPI: 1073417143
Provider Name (Legal Business Name): DRIFTLESS BEHAVIORAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 COUNTY ROAD H
BARNEVELD WI
53507-9576
US

IV. Provider business mailing address

2577 COUNTY ROAD H
BARNEVELD WI
53507-9576
US

V. Phone/Fax

Practice location:
  • Phone: 608-381-4427
  • Fax:
Mailing address:
  • Phone: 608-381-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MARYAM HEYDARI
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 608-381-4427