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General NPI Number Information
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NPI Number | 1457490666
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 3809 MANCHESTER CIR
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City | PLANO
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State | TX
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Zip | 75023-5914
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Country | US
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Telephone | 580-471-6665
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Fax | 910-795-1676
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Provider Business Mailing Address
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Address Line | 3809 MANCHESTER CIR
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City | PLANO
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State | TX
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Zip | 75023-5914
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Country | US
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Telephone | 580-471-6665
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Fax | 910-795-1676
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID HAGEDORN
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Credential | PH.D.
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Telephone | 580-471-6665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32594
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License Number State | TX
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