Healthcare Provider Details

I. General information

NPI: 1285207126
Provider Name (Legal Business Name): CLC BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FEDERAL ST STE 1900
BOSTON MA
02110-1861
US

IV. Provider business mailing address

101 FEDERAL ST STE 1900
BOSTON MA
02110-1861
US

V. Phone/Fax

Practice location:
  • Phone: 617-841-8468
  • Fax:
Mailing address:
  • Phone: 617-841-8468
  • Fax: 617-404-9328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHENELLE CHRISTIAN
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 617-841-8468