Provider Demographics
NPI:1760549893
Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:952-844-0619
Mailing Address - Street 1:4820 77TH ST W STE 135
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4822
Mailing Address - Country:US
Mailing Address - Phone:952-844-0619
Mailing Address - Fax:952-844-0628
Practice Address - Street 1:4820 77TH ST W STE 135
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4822
Practice Address - Country:US
Practice Address - Phone:952-844-0619
Practice Address - Fax:952-844-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1790842821Medicaid
MN4K592BEOtherBCBSMN GROUP #