Provider Demographics
NPI:1538360995
Name:BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEDORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-424-9212
Mailing Address - Street 1:1901 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-2027
Mailing Address - Country:US
Mailing Address - Phone:972-424-9212
Mailing Address - Fax:972-509-1450
Practice Address - Street 1:1901 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-2027
Practice Address - Country:US
Practice Address - Phone:972-424-9212
Practice Address - Fax:972-509-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty