MEDICARE: INLAND BEHAVIORAL AND HEALTH SERVICES, INC.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	363666	OTHER	CA	CALOMIS
2	3666	OTHER	CA	DMC

General Provider Information

NPI Number	:	1275734469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND BEHAVIORAL AND HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1963 N E ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3919
Country	:	US
Telephone Number	:	909-881-6146
Fax Number	:	909-881-3479

Provider Business Practice Location Address
First Line	:	1963 N E ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3919
Country	:	US
Telephone Number	:	909-881-6146
Fax Number	:	909-881-3479

Authorized Official
Title or Position	:	CEO.PRESIDENT
Name	:	DR. TEMETRY ANN LINDSEY
Credential	:	PH.D
Telephone Number	:	909-881-6146

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	08/06/2015

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