Provider Demographics
NPI:1700916517
Name:CHILDRENS BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CHILDRENS BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-714-7230
Mailing Address - Street 1:104 WOODWARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-2347
Mailing Address - Country:US
Mailing Address - Phone:570-714-7230
Mailing Address - Fax:570-714-7231
Practice Address - Street 1:104 WOODWARD HILL RD
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-2347
Practice Address - Country:US
Practice Address - Phone:570-714-7230
Practice Address - Fax:570-714-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization