Provider Demographics
NPI:1386184745
Name:TB CHILDREN'S SERVICES LLC
Entity Type:Organization
Organization Name:TB CHILDREN'S SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREAULT-STRAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LBS
Authorized Official - Phone:267-679-5968
Mailing Address - Street 1:409 CHELSEA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-2305
Mailing Address - Country:US
Mailing Address - Phone:267-679-5968
Mailing Address - Fax:
Practice Address - Street 1:409 CHELSEA RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2305
Practice Address - Country:US
Practice Address - Phone:267-679-5968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002497251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health