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General NPI Number Information
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NPI Number | 1205388907
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE BEHAVIOR SOLUTIONS, LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 2201 N GOVERNMENT WAY SUITE B
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3658
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Country | US
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Telephone | 208-659-5517
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Fax | 800-692-4150
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Provider Business Mailing Address
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Address Line | 2201 N GOVERNMENT WAY STE B
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3658
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Country | US
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Telephone | 208-659-5517
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Fax | 800-692-4150
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JENNIFER EILEEN QUEEN
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Credential | M.ED., BCBA
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Telephone | 208-659-5517
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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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