=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760549893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL MEDICINE ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2007
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4820 77TH ST W STE 135
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-844-0619
-----------------------------------------------------
Fax | 952-844-0628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4820 77TH ST W STE 135
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-844-0619
-----------------------------------------------------
Fax | 952-844-0628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. ELIZABETH M. NASH
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 952-844-0619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------