Provider Demographics
NPI:1063285484
Name:BLUE RIDGE BEHAVIORAL HEALTH ASSOCIATES
Entity type:Organization
Organization Name:BLUE RIDGE BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-C,APRN
Authorized Official - Phone:617-257-3139
Mailing Address - Street 1:37775 HUGHESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-4131
Mailing Address - Country:US
Mailing Address - Phone:617-257-3139
Mailing Address - Fax:
Practice Address - Street 1:37775 HUGHESVILLE RD
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-4131
Practice Address - Country:US
Practice Address - Phone:617-257-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty