Provider Demographics
NPI:1194404319
Name:FUNDAMENTAL BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:FUNDAMENTAL BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP-BC, PMHNP-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUENGER
Authorized Official - Suffix:
Authorized Official - Credentials:FPA-NP
Authorized Official - Phone:618-401-8225
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-0204
Mailing Address - Country:US
Mailing Address - Phone:618-401-8225
Mailing Address - Fax:
Practice Address - Street 1:604 BEVERLY LN
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2912
Practice Address - Country:US
Practice Address - Phone:618-401-8225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health