Provider Demographics
NPI:1932433752
Name:ENTERPRISE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:ENTERPRISE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:JUANITA
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-393-9130
Mailing Address - Street 1:1275 JAMES DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2063
Mailing Address - Country:US
Mailing Address - Phone:334-393-9130
Mailing Address - Fax:
Practice Address - Street 1:1275 JAMES DR
Practice Address - Street 2:SUITE A
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2063
Practice Address - Country:US
Practice Address - Phone:334-393-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1622A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health