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General NPI Number Information
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NPI Number | 1033964713
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Entity Type | Organization
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Legal Business Name | BOUNDLESS BEHAVIORAL SOLUTIONS LLC
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 4663 STENTON AVE STE N115
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City | PHILADELPHIA
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State | PA
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Zip | 19144-3020
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Country | US
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Telephone | 267-251-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 3539 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED BEHAVIOR SPECIALIST
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Name | S BOOKER
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Credential | LBS
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Telephone | 267-251-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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