Basic Information
| Provider Information | |||||||||
| NPI: | 1528417524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 LAKE FOREST BOULEVARD | ||||||||
| Address2: | SUITE 607 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701276201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043247366 | ||||||||
| FaxNumber: | 5043243849 | ||||||||
| Practice Location | |||||||||
| Address1: | 10001 LAKE FOREST BLVD | ||||||||
| Address2: | SUITE 607 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701276200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043247366 | ||||||||
| FaxNumber: | 5043243849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2016 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | JOANN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5043247366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LA | Y | Agencies | Community/Behavioral Health |
No ID Information.