Provider Demographics
NPI:1780307538
Name:BEHAVIORAL HEALTH SOLUTIONS
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISSARH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-343-8753
Mailing Address - Street 1:6313 HASBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5603
Mailing Address - Country:US
Mailing Address - Phone:267-343-8753
Mailing Address - Fax:
Practice Address - Street 1:8080 OLD YORK RD STE 208
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1425
Practice Address - Country:US
Practice Address - Phone:267-343-8753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102417914Medicaid