Provider Demographics
NPI:1003224726
Name:PINETREE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:PINETREE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCPC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCPC
Authorized Official - Phone:207-307-7119
Mailing Address - Street 1:263 STATE STREET SUITE 9
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5435
Mailing Address - Country:US
Mailing Address - Phone:207-307-7119
Mailing Address - Fax:207-307-7129
Practice Address - Street 1:263 STATE ST STE 9
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5461
Practice Address - Country:US
Practice Address - Phone:207-307-7119
Practice Address - Fax:207-307-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty