Provider Demographics
NPI:1124808456
Name:BEEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BEEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAYDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMMEKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-823-9925
Mailing Address - Street 1:71566 FLORIDA DR
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-4070
Mailing Address - Country:US
Mailing Address - Phone:360-823-9925
Mailing Address - Fax:
Practice Address - Street 1:71566 FLORIDA DR
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-4070
Practice Address - Country:US
Practice Address - Phone:360-823-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty