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NPI Code Detail

MEDICARE: INTEGRATED BEHAVIORAL HEALTH NETWORK

MEDICARE: INTEGRATED BEHAVIORAL HEALTH NETWORK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YA0400XAddiction (Substance Use Disorder) Counselor
3101YM0800XMental Health Counselor
4101YP2500XProfessional Counselor
5103T00000XPsychologist
6251S00000XCommunity/Behavioral Health Agency
7261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
8261QM0850XAdult Mental Health Clinic/Center
9261QM0855XAdolescent and Children Mental Health Clinic/Center
10324500000XSubstance Abuse Rehabilitation Facility
11305S00000XPoint of Service

General Provider Information

NPI Number : 1215492103
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED BEHAVIORAL HEALTH NETWORK
Provider Business Mailing Address
First Line : 4430 114TH ST
Second Line :
City : URBANDALE
State : IA
Zip : 50322-5409
Country : US
Telephone Number : 515-450-4919
Fax Number :
Provider Business Practice Location Address
First Line : 4430 114TH ST
Second Line :
City : URBANDALE
State : IA
Zip : 50322-5409
Country : US
Telephone Number : 515-450-4919
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DUSTIN HEMESATH
Credential :
Telephone Number : 515-450-4919
Provider Enumeration Date : 02/05/2019
Last Update Date : 02/05/2019

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Directions to “INTEGRATED BEHAVIORAL HEALTH NETWORK ” Practice Location

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