Healthcare Provider Details

I. General information

NPI: 1629322342
Provider Name (Legal Business Name): MB BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MITCHELL ST SW SUITE 450
ATLANTA GA
30303-3304
US

IV. Provider business mailing address

49 HUDSON VIEW TER
NEWBURGH NY
12550-3310
US

V. Phone/Fax

Practice location:
  • Phone: 845-597-4264
  • Fax:
Mailing address:
  • Phone: 845-597-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY JACKSON
Title or Position: OWNER
Credential:
Phone: 845-597-4264