Provider Demographics
NPI:1568194157
Name:BEHAVIORAL THERAPY AND CARE, LLC
Entity type:Organization
Organization Name:BEHAVIORAL THERAPY AND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER. OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:208-206-7840
Mailing Address - Street 1:898 ABIGAIL COURT
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:898 ABIGAIL COURT
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406
Practice Address - Country:UM
Practice Address - Phone:208-206-7840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID106S00000XMedicaid