Organization
BAPTIST BEHAVIORAL HEALTH, LLC
Active
Parent organization
BAPTIST BEHAVIORAL HEALTH, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BAPTIST BEHAVIORAL HEALTH, LLC
Authorized official
ELIZABETH TISH DE MEDICI (CREDENTIALING MGR)
(904) 376-3800
Entity
Organization
Contact information
Practice address
3650 NW DEVANE ST, LAKE CITY, FL 32055-8730
(904) 376-3800
(904) 376-3998
Mailing address
PO BOX 748519, ATLANTA, GA 30374-8519
(904) 376-3800
(904) 376-3998
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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