| Organization Name: | CHILDREN'S CENTER FOR BEHAVIORAL DEVELOPMENT |
| NPI Number: | 1184677619 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAROLYN BIRTH (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 353 N 88th St East Saint Louis |
| State: | IL US |
| Postal Code: | 622032705 |
| Phone Number: | 6183981152 |
| Fax Number: | 6183986977 |
| NPI Enumeration Date: | 05/18/2006 |
| NPI Last Update Date: | 07/26/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 101YM0800X |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |