MEDICARE: INTEGRATIVE BEHAVIORAL HEALTH AND ALTERNATIVE HEALING ARTS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1639793888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE BEHAVIORAL HEALTH AND ALTERNATIVE HEALING ARTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 223
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42302-0223
Country	:	US
Telephone Number	:	270-313-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 SWEENEY ST STE 102
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-3834
Country	:	US
Telephone Number	:	270-313-2988
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TERRY L JANELLE
Credential	:	LPCC
Telephone Number	:	270-313-2988

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	04/15/2026

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