Provider Demographics
NPI:1962984328
Name:BOX ELDER BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:BOX ELDER BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURNO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-274-7527
Mailing Address - Street 1:254 RAINBOW RIDGE
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-4856
Mailing Address - Country:US
Mailing Address - Phone:757-274-7527
Mailing Address - Fax:757-530-5196
Practice Address - Street 1:254 RAINBOW RIDGE
Practice Address - Street 2:
Practice Address - City:BUMPASS
Practice Address - State:VA
Practice Address - Zip Code:23024-4856
Practice Address - Country:US
Practice Address - Phone:757-274-7527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-02
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701004212261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty