Provider Demographics
NPI:1588267058
Name:BEHAVIOR THERAPY SERVICE, LLC
Entity type:Organization
Organization Name:BEHAVIOR THERAPY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-644-8846
Mailing Address - Street 1:PO BOX 16667
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-6667
Mailing Address - Country:US
Mailing Address - Phone:575-644-8846
Mailing Address - Fax:575-522-5717
Practice Address - Street 1:5075 CHATO CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-9728
Practice Address - Country:US
Practice Address - Phone:575-644-8846
Practice Address - Fax:575-522-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty