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General NPI Number Information
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NPI Number | 1396128088
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Entity Type | Organization
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Legal Business Name | INNOVATIVE BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 3721 W MICHIGAN AVE STE 200
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City | LANSING
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State | MI
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Zip | 48917-3600
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Country | US
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Telephone | 517-515-6176
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Fax |
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Provider Business Mailing Address
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Address Line | 3721 W MICHIGAN AVE STE 200
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City | LANSING
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State | MI
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Zip | 48917-3600
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Country | US
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Telephone | 517-515-6176
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/OFFICE MANAGER
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Name | MRS. CANDACE LYNN TILLERY
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Credential |
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Telephone | 517-213-8185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6801094835
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C-02622
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 6801094835
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801094835
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801094835
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License Number State | MI
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