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General NPI Number Information
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NPI Number | 1881103224
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Entity Type | Organization
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Legal Business Name | INNOVATIVE BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 26750 S DIXIE HWY
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City | HOMESTEAD
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State | FL
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Zip | 33032-7431
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Country | US
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Telephone | 786-712-2314
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Fax |
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Provider Business Mailing Address
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Address Line | 1938 SE 22ND CT
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City | HOMESTEAD
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State | FL
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Zip | 33035-1238
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Country | US
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Telephone | 786-712-2314
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | LUCKNER C DENORD
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Credential |
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Telephone | 786-712-2314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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