MEDICARE: THERAPEUTIC BEHAVIORAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952423733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 77165
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27417-7165
Country	:	US
Telephone Number	:	336-299-0754
Fax Number	:	336-299-0755

Provider Business Practice Location Address
First Line	:	1527 EARL DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-4807
Country	:	US
Telephone Number	:	336-299-0754
Fax Number	:	336-299-0755

Authorized Official
Title or Position	:	EXECUTIVE OFFICER
Name	:	WANDA KNIGHT
Credential	:
Telephone Number	:	336-299-0754

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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