MEDICARE: INTEGRATED BEHAVIORAL HEALTH, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	2084P0804X	Child & Adolescent Psychiatry Physician
3	2084P0805X	Geriatric Psychiatry Physician
4	363LF0000X	Family Nurse Practitioner
5	101YP2500X	Professional Counselor
6	104100000X	Social Worker
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1730522699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	600 SUN TEMPLE DRIVE
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-5919
Country	:	US
Telephone Number	:	256-288-3333
Fax Number	:	256-288-3334

Provider Business Practice Location Address
First Line	:	600 SUN TEMPLE DRIVE
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-5919
Country	:	US
Telephone Number	:	256-288-3333
Fax Number	:	256-288-3334

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	KELLI HARDIN
Credential	:
Telephone Number	:	256-288-3333

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	08/26/2019

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