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General NPI Number Information
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NPI Number | 1902590565
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE BEHAVIORAL CARE LLC
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/11/2023
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Provider Practice Location Address
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Address Line | 501 KREBS AVE STE C
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City | PASCAGOULA
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State | MS
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Zip | 39567-3123
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Country | US
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Telephone | 225-302-0196
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Fax |
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Provider Business Mailing Address
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Address Line | 10632 HOLLY HOCK DR
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City | GREENWELL SPRINGS
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State | LA
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Zip | 70739-5312
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Country | US
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Telephone | 225-302-0196
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LATOYA BURKS
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Credential |
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Telephone | 225-302-0196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 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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