Organization
CHILDREN'S CENTER FOR BEHAVIORAL DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN BIRTH (CHIEF EXECUTIVE OFFICER)
(618) 398-1152
Entity
Organization
Contact information
Practice address
353 N 88TH ST, EAST SAINT LOUIS, IL 62203-2705
(618) 398-1152
(618) 398-6977
Mailing address
353 N 88TH ST, EAST SAINT LOUIS, IL 62203-2705
(618) 398-1152
(618) 398-6977
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
165005001
IL
101YM0800X
Mental Health Counselor
101YM0800X
IL
Other
Enumeration date
05/18/2006
Last updated
07/26/2007
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