Healthcare Provider Details

I. General information

NPI: 1700814712
Provider Name (Legal Business Name): PROTEA BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 STATE ST
BANGOR ME
04401-5038
US

IV. Provider business mailing address

33 STATE ST
BANGOR ME
04401-5038
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-7010
  • Fax: 207-992-7011
Mailing address:
  • Phone: 207-992-7010
  • Fax: 207-992-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateME

VIII. Authorized Official

Name: MRS. ROWENA TESSMANN
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 207-992-7010