Provider Demographics
NPI:1124141023
Name:BEHAVIOR STRATEGIES
Entity type:Organization
Organization Name:BEHAVIOR STRATEGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:I
Authorized Official - Last Name:BOW
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:208-308-8585
Mailing Address - Street 1:202 14TH AVE E
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1829
Mailing Address - Country:US
Mailing Address - Phone:208-308-8585
Mailing Address - Fax:208-934-4688
Practice Address - Street 1:202 14TH AVE E
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1829
Practice Address - Country:US
Practice Address - Phone:208-308-8585
Practice Address - Fax:208-934-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8073575Medicaid