Organization
WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Active
Organization
WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SENIOR DIRECTOR PROVIDER ENROLLMENT)
(877) 892-9815
Entity
Organization
Contact information
Practice address
562 WYOMING AVE, KINGSTON, PA 18704-3721
(570) 552-3865
(570) 552-3875
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102288577-0005
—
PA
Enumeration date
05/01/2009
Last updated
01/25/2022
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