Provider Demographics
NPI:1104128156
Name:BEHAVIORAL HEALTH ASSOCIATES, LTD.
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-246-9036
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-0040
Mailing Address - Country:US
Mailing Address - Phone:800-246-9036
Mailing Address - Fax:888-688-4095
Practice Address - Street 1:1132 28TH AVE S
Practice Address - Street 2:SUITE 105A
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4420
Practice Address - Country:US
Practice Address - Phone:800-246-9036
Practice Address - Fax:888-688-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA470016300103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty