Provider Demographics
NPI:1366519761
Name:BEHAVIORAL TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:BEHAVIORAL TREATMENT CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUEGERL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-234-2600
Mailing Address - Street 1:210 E CENTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6326
Mailing Address - Country:US
Mailing Address - Phone:208-234-2600
Mailing Address - Fax:208-234-2800
Practice Address - Street 1:210 E CENTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6326
Practice Address - Country:US
Practice Address - Phone:208-234-2600
Practice Address - Fax:208-234-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806902500Medicaid