Provider Demographics
NPI:1922816115
Name:MBA BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:MBA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-651-6890
Mailing Address - Street 1:9608 HONEY TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3298
Mailing Address - Country:US
Mailing Address - Phone:804-651-6890
Mailing Address - Fax:
Practice Address - Street 1:801 TRAVIS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-5719
Practice Address - Country:US
Practice Address - Phone:804-651-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management