MEDICARE: BEHAVIOR MANAGEMENT TREATMENT SERVICES,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194261586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIOR MANAGEMENT TREATMENT SERVICES,LLC

Provider Business Mailing Address
First Line	:	1905 HUGUENOT RD
Second Line	:	SUITE 306
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4312
Country	:	US
Telephone Number	:	804-218-5649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 HUGUENOT RD
Second Line	:	SUITE 306
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4312
Country	:	US
Telephone Number	:	804-218-5649
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAMBLET SMITH JOHNSON
Credential	:
Telephone Number	:	804-218-5649

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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