Provider Demographics
NPI:1104424464
Name:CBL II, LLC
Entity type:Organization
Organization Name:CBL II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHELI
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-335-4545
Mailing Address - Street 1:163 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3730
Mailing Address - Country:US
Mailing Address - Phone:860-693-4605
Mailing Address - Fax:
Practice Address - Street 1:163 ROBIN DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3730
Practice Address - Country:US
Practice Address - Phone:860-693-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health