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General NPI Number Information
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NPI Number | 1396386785
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Entity Type | Organization
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Legal Business Name | INTEGRATED BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 17100 SILVER PKWY STE D
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City | FENTON
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State | MI
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Zip | 48430-3468
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Country | US
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Telephone | 810-208-0378
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Fax | 810-963-1917
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Provider Business Mailing Address
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Address Line | 17100 SILVER PKWY STE D
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City | FENTON
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State | MI
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Zip | 48430-3468
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Country | US
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Telephone | 810-208-0378
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Fax | 810-963-1917
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Authorized Official
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Title or Position | PRACTICE MANAGER/PSYCHOTHERAPIST
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Name | ALISHA RAE MCCABE
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Credential |
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Telephone | 810-922-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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