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General NPI Number Information
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NPI Number | 1285207126
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Entity Type | Organization
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Legal Business Name | CLC BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 101 FEDERAL ST STE 1900
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City | BOSTON
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State | MA
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Zip | 02110-1861
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Country | US
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Telephone | 617-841-8468
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Fax |
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Provider Business Mailing Address
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Address Line | 101 FEDERAL ST STE 1900
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City | BOSTON
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State | MA
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Zip | 02110-1861
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Country | US
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Telephone | 617-841-8468
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Fax | 617-404-9328
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | CHENELLE CHRISTIAN
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Credential | NP
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Telephone | 617-841-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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