MEDICARE: INTEGRATED BEHAVIORAL HEALTH SOLUTIONS, LLC

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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1336442771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED BEHAVIORAL HEALTH SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1875 BRIGHTSEAT RD
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4250
Country	:	US
Telephone Number	:	301-341-0081
Fax Number	:	301-341-0087

Provider Business Practice Location Address
First Line	:	1875 BRIGHTSEAT RD
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4250
Country	:	US
Telephone Number	:	301-341-0081
Fax Number	:	301-341-0087

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MR. BERNARD AKINSEYE
Credential	:
Telephone Number	:	301-341-0081

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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