Healthcare Provider Details

I. General information

NPI: 1477084952
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 03/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LINDENWOOD DR STE 225
MALVERN PA
19355-1762
US

IV. Provider business mailing address

101 LINDENWOOD DR STE 225
MALVERN PA
19355-1762
US

V. Phone/Fax

Practice location:
  • Phone: 610-504-4476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BOLAJI BANKOLE
Title or Position: OWNER
Credential:
Phone: 610-504-4476