Provider Demographics
NPI:1063582195
Name:BEHAVIORAL MEDICINE ASSOCIATES LLC
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIMZEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:308-534-4872
Mailing Address - Street 1:220 W LEOTA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6293
Mailing Address - Country:US
Mailing Address - Phone:308-534-4872
Mailing Address - Fax:
Practice Address - Street 1:220 W LEOTA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6293
Practice Address - Country:US
Practice Address - Phone:308-534-4872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE675103TC0700X
NE208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025443100Medicaid
NE10025443100Medicaid