Healthcare Provider Details

I. General information

NPI: 1649744525
Provider Name (Legal Business Name): INDEPENDENCE BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451B US HIGHWAY 17
RICHMOND HILL GA
31324-3397
US

IV. Provider business mailing address

5203 MARYLAND WAY STE 104
BRENTWOOD TN
37027-5022
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone: 615-560-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SPENCER CUMMINGS
Title or Position: VP, FINANCE
Credential:
Phone: 615-560-6622