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General NPI Number Information
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NPI Number | 1255500377
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE BEHAVIORAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 505 S 8TH ST
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City | EAST SAINT LOUIS
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State | IL
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Zip | 62201-2919
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Country | US
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Telephone | 618-482-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S 8TH ST
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City | EAST SAINT LOUIS
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State | IL
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Zip | 62201-2919
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Country | US
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Telephone | 618-482-7330
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOSEPH HARPER
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Credential | LCSW, MBA, CADC
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Telephone | 618-482-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 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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