Provider Demographics
NPI:1194261586
Name:BEHAVIOR MANAGEMENT TREATMENT SERVICES,LLC
Entity type:Organization
Organization Name:BEHAVIOR MANAGEMENT TREATMENT SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMBLET
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-218-5649
Mailing Address - Street 1:1905 HUGUENOT RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4312
Mailing Address - Country:US
Mailing Address - Phone:804-218-5649
Mailing Address - Fax:
Practice Address - Street 1:1905 HUGUENOT RD
Practice Address - Street 2:SUITE 306
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4312
Practice Address - Country:US
Practice Address - Phone:804-218-5649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health