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General NPI Number Information
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NPI Number | 1912731845
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 09/02/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 120 N MAIN ST STE 302
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City | ATTLEBORO
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State | MA
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Zip | 02703-2248
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Country | US
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Telephone | 781-414-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 120 N MAIN ST STE 302
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City | ATTLEBORO
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State | MA
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Zip | 02703-2248
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Country | US
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Telephone | 781-414-0099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THERESA S BOUGOUNEAU
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Credential | LMHC,LADC-1,MCCS
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Telephone | 781-414-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 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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