Provider Demographics
NPI:1255601951
Name:ST. CROIX BEHAVIORAL HEALTH CENTER, LLC
Entity type:Organization
Organization Name:ST. CROIX BEHAVIORAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:340-692-2600
Mailing Address - Street 1:113 BARREN SPOT
Mailing Address - Street 2:THE VILLAGE MALL SUITE 107
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00850
Mailing Address - Country:US
Mailing Address - Phone:340-692-2600
Mailing Address - Fax:340-692-2602
Practice Address - Street 1:113 BARREN SPOT
Practice Address - Street 2:THE VILLAGE MALL SUITE 107
Practice Address - City:KINGSHILL
Practice Address - State:VI
Practice Address - Zip Code:00850
Practice Address - Country:US
Practice Address - Phone:340-692-2600
Practice Address - Fax:340-692-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-14664-1L261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)