Provider Demographics
NPI:1164148847
Name:JB BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:JB BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARBACIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:920-639-1032
Mailing Address - Street 1:301 N BROADWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2571
Mailing Address - Country:US
Mailing Address - Phone:920-425-4900
Mailing Address - Fax:920-425-4200
Practice Address - Street 1:301 N BROADWAY STE 110
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2571
Practice Address - Country:US
Practice Address - Phone:920-425-4900
Practice Address - Fax:920-425-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health