Healthcare Provider Details

I. General information

NPI: 1386025351
Provider Name (Legal Business Name): INTEGRATED BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 11/02/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 FORBES BLVD STE 110
LANHAM MD
20706-4374
US

IV. Provider business mailing address

12404 WINDING LN
BOWIE MD
20715-1234
US

V. Phone/Fax

Practice location:
  • Phone: 301-499-4240
  • Fax: 240-455-6847
Mailing address:
  • Phone: 202-607-6932
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SATWANT KAUR
Title or Position: OWNER
Credential:
Phone: 202-607-6932