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General NPI Number Information
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NPI Number | 1982887105
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Entity Type | Organization
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Legal Business Name | INDIVIDUALIZED BEHAVIOR SOLUTIONS, LLC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 6675 NW MEYERS CIR
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City | PARKVILLE
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State | MO
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Zip | 64152-5220
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Country | US
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Telephone | 913-522-4775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 901863
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City | KANSAS CITY
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State | MO
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Zip | 64190-1863
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Country | US
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Telephone | 913-522-4775
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LISA M. MILLER
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Credential |
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Telephone | 913-522-4775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 2010042683
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License Number State | MO
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