MEDICARE: IOP BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1164202420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOP BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	350 SUN TEMPLE DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-5919
Country	:	US
Telephone Number	:	256-693-5301
Fax Number	:	256-693-5301

Provider Business Practice Location Address
First Line	:	350 SUN TEMPLE DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-5919
Country	:	US
Telephone Number	:	256-693-5301
Fax Number	:	256-693-5301

Authorized Official
Title or Position	:	DIRECTOR/AUTHORIZED OFFICIAL
Name	:	SHARA M BLACKWELL
Credential	:
Telephone Number	:	256-975-4291

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	04/07/2026

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