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General NPI Number Information
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NPI Number | 1689843179
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MEDICINE ASSOCIATES INC
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 5470 KIETZKE LN STE 300
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City | RENO
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State | NV
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Zip | 89511-2099
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Country | US
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Telephone | 775-827-8883
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Fax | 866-476-4317
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Provider Business Mailing Address
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Address Line | 5470 KIETZKE LN STE 300
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City | RENO
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State | NV
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Zip | 89511-2099
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Country | US
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Telephone | 775-827-8883
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Fax | 866-476-4317
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | BLAKE H TEARNAN
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Credential | PH.D.
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Telephone | 775-827-8883
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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 | PSY142
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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