MEDICARE: PROBEHAVIORAL 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1326737826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROBEHAVIORAL LLC

Provider Business Mailing Address
First Line	:	10343 YELLOW LOCUST LN
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-9470
Country	:	US
Telephone Number	:	937-602-1861
Fax Number	:

Provider Business Practice Location Address
First Line	:	6210 BELLEFONTAINE RD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-4009
Country	:	US
Telephone Number	:	937-236-1800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMARJEET SINGH BIRDI
Credential	:	MD
Telephone Number	:	937-602-1861

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/02/2023

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