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General NPI Number Information
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NPI Number | 1164148847
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Entity Type | Organization
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Legal Business Name | JB BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 12/24/2022
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Provider Practice Location Address
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Address Line | 301 N BROADWAY STE 110
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City | DE PERE
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State | WI
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Zip | 54115-2571
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Country | US
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Telephone | 920-425-4900
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Fax | 920-425-4200
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Provider Business Mailing Address
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Address Line | 301 N BROADWAY STE 110
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City | DE PERE
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State | WI
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Zip | 54115-2571
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Country | US
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Telephone | 920-425-4900
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Fax | 920-425-4200
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | JUSTINE M. GARBACIAK
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Credential | MS, LPC
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Telephone | 920-639-1032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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