1588013882 NPI number — CHILDRENS BEHAVIORAL HEALTH CENTER

Table of content: MR. JEFFREY TIMOTHY WILLSEY CNMT (NPI 1437374808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588013882 NPI number — CHILDRENS BEHAVIORAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS BEHAVIORAL HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588013882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
848 W KINGS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COATESVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19320-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-212-0738
Provider Business Mailing Address Fax Number:
610-383-9494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
848 W KINGS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COATESVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19320-1714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-212-0738
Provider Business Practice Location Address Fax Number:
610-383-9494
Provider Enumeration Date:
06/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KOSSOR
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
ALBERT
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
610-212-0738

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  PS003680L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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