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General NPI Number Information
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NPI Number | 1932333655
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Entity Type | Organization
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Legal Business Name | CHILD AND ADOLESCENT BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 919 2ND ST NE
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City | CANTON
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State | OH
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Zip | 44704-1132
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Country | US
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Telephone | 330-454-7917
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Fax |
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Provider Business Mailing Address
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Address Line | 919 2ND ST NE
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City | CANTON
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State | OH
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Zip | 44704-1132
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Country | US
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Telephone | 330-454-7917
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Fax |
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Authorized Official
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Title or Position | TRAINED OTHER
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Name | MS. KATHY SUZANNE MOORE
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Credential | B.A.
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Telephone | 330-454-7917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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