Provider Demographics
NPI:1902089857
Name:BEHAVIOR, ATTENTION, AND DEVELOPMENTAL DISABILITIES CONSULTANTS, LLC
Entity Type:Organization
Organization Name:BEHAVIOR, ATTENTION, AND DEVELOPMENTAL DISABILITIES CONSULTANTS, LLC
Other - Org Name:INTEGRATED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:662-609-4950
Mailing Address - Street 1:4628 UNION RD
Mailing Address - Street 2:
Mailing Address - City:SARDIS
Mailing Address - State:MS
Mailing Address - Zip Code:38666-3280
Mailing Address - Country:US
Mailing Address - Phone:662-609-4950
Mailing Address - Fax:844-445-7727
Practice Address - Street 1:5779 GETWELL RD BLDG D3
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6351
Practice Address - Country:US
Practice Address - Phone:662-510-6507
Practice Address - Fax:662-510-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ055944Medicaid
MS00634747Medicaid