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General NPI Number Information
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NPI Number | 1003224726
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Entity Type | Organization
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Legal Business Name | PINETREE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 263 STATE ST STE 9
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City | BANGOR
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State | ME
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Zip | 04401-5461
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Country | US
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Telephone | 207-307-7119
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Fax | 207-307-7129
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Provider Business Mailing Address
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Address Line | 263 STATE STREET SUITE 9
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City | BANGOR
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State | ME
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Zip | 04401-5435
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Country | US
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Telephone | 207-307-7119
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Fax | 207-307-7129
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Authorized Official
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Title or Position | OWNER/LCPC
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Name | DR. CHRISTOPHER GARRISON
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Credential | ED.D., LCPC
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Telephone | 207-307-7119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC1731
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License Number State | ME
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