Provider Demographics
NPI:1326217233
Name:CHILDREN'S BEHAVIORAL HEALTH SERVICES, LLP
Entity Type:Organization
Organization Name:CHILDREN'S BEHAVIORAL HEALTH SERVICES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/LICENSED PROFESSIONAL COUNS
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:AILENE
Authorized Official - Last Name:BRUNER-LEYDENS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:262-657-5026
Mailing Address - Street 1:6021 56TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3087
Mailing Address - Country:US
Mailing Address - Phone:262-657-5026
Mailing Address - Fax:262-657-5663
Practice Address - Street 1:6021 56TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3087
Practice Address - Country:US
Practice Address - Phone:262-657-5026
Practice Address - Fax:262-657-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8137-125251S00000X
WI3146-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health