Provider Demographics
NPI:1487085296
Name:BEHAVIORAL HEALTH AND CONSULTING PRACTICE, LLC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH AND CONSULTING PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PC
Authorized Official - Phone:617-332-0422
Mailing Address - Street 1:PO BOX 620024
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-0024
Mailing Address - Country:US
Mailing Address - Phone:617-332-0422
Mailing Address - Fax:617-332-0423
Practice Address - Street 1:846 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1756
Practice Address - Country:US
Practice Address - Phone:617-332-0422
Practice Address - Fax:617-332-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN154473364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPENDINGMedicare UPIN