Fundamental Behavioral Health

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

FUNDAMENTAL BEHAVIORAL HEALTH

Practice address

604 Beverly LN
Collinsville, IL 62234-2912

Phone

(618) 401-8225

NPI assigned

Jul 14, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Joellen Juenger, FPA-NPNPI 1578970505

Title

FNP-BC, Pmhnp-BC

Phone

(618) 401-8225

Specialties & licenses 1

Addresses

Other names 1

• Fundamental Behavioral Health Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joellen Juenger, APN

  • Family Nurse Practitioner
  • Granite City, IL
  • NPI 1578970505
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1194404319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 204",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622340204",
            "telephone_number": "618-401-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 BEVERLY LN",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622342912",
            "telephone_number": "618-401-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDAMENTAL BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-14",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "JUENGER",
        "authorized_official_first_name": "JOELLEN",
        "authorized_official_title_or_position": "FNP-BC, PMHNP-BC",
        "authorized_official_telephone_number": "618-401-8225",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FPA-NP"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fundamental Behavioral Health",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Fundamental Behavioral Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Anthony Webster Fourdyce, DC
• Fox Med-Equip Service Corp
• Charles L Friedman, MD
• Adam Fritzgerald, DMD
• Elizabeth Anne Frost, ANP
• Sarah Elizabeth Gafford, LCSW
• Shelby F Garvey
• Gateway Anesthesia
• Gateway Dental Group of Illinois LLC
• Danica Lee Ann Geaslin Byler, LCPC

• Adolescent and Children Mental Health Clinic/Center in Collinsville, IL
• Providers in Collinsville, IL by specialty
• Adolescent and Children Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.