Provider Demographics
NPI:1558860833
Name:LLC BEHAVIOR SERVICES
Entity type:Organization
Organization Name:LLC BEHAVIOR SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA CAADC SPADA
Authorized Official - Phone:616-723-5071
Mailing Address - Street 1:1960 MILLBROOK ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-2636
Mailing Address - Country:US
Mailing Address - Phone:616-723-5071
Mailing Address - Fax:201-849-7865
Practice Address - Street 1:1960 MILLBROOK ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-2636
Practice Address - Country:US
Practice Address - Phone:616-633-3700
Practice Address - Fax:616-633-3700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARD PHILOSPHER MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-01
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00112101YA0400X, 171M00000X
6803085788104100000X
C-00112405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty