Provider Demographics
NPI:1861157448
Name:BEHLMER, DANA A
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:BEHLMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6195 MIDDLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2048
Mailing Address - Country:US
Mailing Address - Phone:775-323-4242
Mailing Address - Fax:
Practice Address - Street 1:6195 MIDDLE LAKE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2048
Practice Address - Country:US
Practice Address - Phone:775-323-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NV01026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11870645OtherNV
NV11870645OtherCAQH