Provider Demographics
NPI:1487160602
Name:BARDIN BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:BARDIN BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BARDIN
Authorized Official - Suffix:III
Authorized Official - Credentials:BCBA
Authorized Official - Phone:803-394-5619
Mailing Address - Street 1:3401 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6934
Mailing Address - Country:US
Mailing Address - Phone:803-394-5619
Mailing Address - Fax:803-339-1907
Practice Address - Street 1:3401 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6934
Practice Address - Country:US
Practice Address - Phone:803-394-5619
Practice Address - Fax:803-339-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-28411103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922477934OtherNPI
14172597OtherCAQH