=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164202420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IOP BEHAVIORAL HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2023
-----------------------------------------------------
Last Update Date | 04/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 SUN TEMPLE DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-5919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-693-5301
-----------------------------------------------------
Fax | 256-693-5301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 SUN TEMPLE DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-5919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-693-5301
-----------------------------------------------------
Fax | 256-693-5301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | SHARA M BLACKWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-975-4291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------