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JACKSONVILLE BEHAVIOR AND MENTAL HEALTH NPI 1770771750


NPI Information

NPI: 1770771750
Provider Name: JACKSONVILLE BEHAVIOR AND MENTAL HEALTH
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

CLIA Number: 34D2064790

Address:
156 MEMORIAL CT
JACKSONVILLE, NC
ZIP 28546
Phone: (910) 353-0680
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JACKSONVILLE BEHAVIOR AND MENTAL HEALTH is an adolescent and children mental health clinic center in Jacksonville, NC. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. JACKSONVILLE BEHAVIOR AND MENTAL HEALTH NPI is 1770771750. The provider is registered as an organization entity type.

The provider's business location address is:

156 MEMORIAL CT
JACKSONVILLE, NC
ZIP 28546-322
Phone: (910) 353-0680
Fax: (910) 353-3629

The provider's authorized official is Madhur Mittal .
The authorized official title is President and has the following contact phone number (910) 353-0581.

The CLIA number assigned to this NPI record is 34D2064790 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/4/2007 and was last updated on 7/8/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthNo
2261QM0855XClinic/CenterAdolescent and Children Mental Health3758NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
18901904MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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