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General NPI Number Information
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NPI Number | 1932433752
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Entity Type | Organization
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Legal Business Name | ENTERPRISE BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 1275 JAMES DR SUITE A
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City | ENTERPRISE
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State | AL
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Zip | 36330-2063
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Country | US
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Telephone | 334-393-9130
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 JAMES DR SUITE A
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City | ENTERPRISE
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State | AL
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Zip | 36330-2063
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Country | US
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Telephone | 334-393-9130
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | CRYSTAL JUANITA CHRISTIAN
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Credential |
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Telephone | 334-393-9130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C1622A
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License Number State | AL
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