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General NPI Number Information
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NPI Number | 1396221701
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC BEHAVIORAL INTERVENTIONS
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 159 MAIN ST STE M
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City | AGAWAM
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State | MA
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Zip | 01001-1804
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Country | US
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Telephone | 413-348-6967
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Fax |
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Provider Business Mailing Address
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Address Line | 159 MAIN ST STE M
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City | AGAWAM
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State | MA
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Zip | 01001-1804
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Country | US
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Telephone | 413-348-6967
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MS. KRISTEN ANN KOCOT
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Credential | M.A., LMHC
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Telephone | 413-348-6967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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