Provider Demographics
NPI:1366620643
Name:BEHAVIORAL MEDICINE, PLLC
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-642-4422
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-0731
Mailing Address - Country:US
Mailing Address - Phone:731-642-4422
Mailing Address - Fax:731-642-0068
Practice Address - Street 1:401 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4821
Practice Address - Country:US
Practice Address - Phone:731-642-4422
Practice Address - Fax:731-642-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDE4535OtherRR MEDICARE
TN3723326Medicaid
MS09014277Medicaid
KY64053168Medicaid
TNDE4535OtherRR MEDICARE