Healthcare Provider Details

I. General information

NPI: 1912731845
Provider Name (Legal Business Name): TREE OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N MAIN ST STE 302
ATTLEBORO MA
02703-2248
US

IV. Provider business mailing address

120 N MAIN ST STE 302
ATTLEBORO MA
02703-2248
US

V. Phone/Fax

Practice location:
  • Phone: 781-414-0099
  • Fax:
Mailing address:
  • Phone: 781-414-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA S BOUGOUNEAU
Title or Position: OWNER
Credential: LMHC,LADC-1,MCCS
Phone: 781-414-0099