Healthcare Provider Details

I. General information

NPI: 1306079223
Provider Name (Legal Business Name): BURLINGTON BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 MILWAUKEE AVE SUITE 3C
BURLINGTON WI
53105-1254
US

IV. Provider business mailing address

565 MILWAUKEE AVE SUITE 3C
BURLINGTON WI
53105-1254
US

V. Phone/Fax

Practice location:
  • Phone: 262-757-0016
  • Fax: 262-757-0018
Mailing address:
  • Phone: 262-757-0016
  • Fax: 262-757-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. DON CROWDER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D
Phone: 262-757-0016