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General NPI Number Information
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NPI Number | 1104128156
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH ASSOCIATES, LTD.
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 1132 28TH AVE S SUITE 105A
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City | MOORHEAD
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State | MN
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Zip | 56560-4420
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Country | US
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Telephone | 800-246-9036
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Fax | 888-688-4095
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | PAYNESVILLE
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State | MN
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Zip | 56362-0040
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Country | US
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Telephone | 800-246-9036
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Fax | 888-688-4095
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. JEFFREY LUNDQUIST
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Credential |
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Telephone | 800-246-9036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | A470016300
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License Number State | MN
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