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General NPI Number Information
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NPI Number | 1629322342
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Entity Type | Organization
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Legal Business Name | MB BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 233 MITCHELL ST SW SUITE 450
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City | ATLANTA
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State | GA
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Zip | 30303-3304
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Country | US
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Telephone | 845-597-4264
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Fax |
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Provider Business Mailing Address
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Address Line | 49 HUDSON VIEW TER
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City | NEWBURGH
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State | NY
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Zip | 12550-3310
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Country | US
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Telephone | 845-597-4264
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TIFFANY JACKSON
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Credential |
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Telephone | 845-597-4264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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