Organization Name: | MEDOPTIONS BEHAVIORAL HEALTH ASSOCIATES LLC |
NPI Number: | 1144421157 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLY JOHNSON (CREDENTIALING COORDINATOR) |
Mailing Address: | 20 Research Pkwy Old Saybrook |
State: | CT US |
Postal Code: | 064754214 |
Phone Number: | 8003703651 |
Fax Number: | 8605100020 |
NPI Enumeration Date: | 05/29/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |