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General NPI Number Information
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NPI Number | 1871672642
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Entity Type | Organization
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Legal Business Name | TEEN RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 MEADOWS SHOPPING CTR # L
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City | TERRE HAUTE
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State | IN
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Zip | 47803-2373
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Country | US
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Telephone | 812-234-3838
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Fax | 812-234-5026
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Provider Business Mailing Address
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Address Line | 7 MEADOWS SHOPPING CTR # L
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City | TERRE HAUTE
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State | IN
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Zip | 47803-2373
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Country | US
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Telephone | 812-234-3838
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Fax | 812-234-5026
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Authorized Official
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Title or Position | OWNER
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Name | ROBBE CHRISMAN
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Credential | MS
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Telephone | 812-234-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 20041149A
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License Number State | IN
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