Provider Demographics
NPI:1730826728
Name:AGM BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:AGM BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANIAMARIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-294-4113
Mailing Address - Street 1:221 W HALLANDALE BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5441
Mailing Address - Country:US
Mailing Address - Phone:786-294-4113
Mailing Address - Fax:
Practice Address - Street 1:221 W HALLANDALE BEACH BLVD STE 220
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5441
Practice Address - Country:US
Practice Address - Phone:786-294-4113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty