Provider Demographics
NPI:1023180387
Name:INNOVATIVE INTERVENTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE INTERVENTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DINEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFT
Authorized Official - Phone:317-890-5722
Mailing Address - Street 1:9670 E WASHINGTON ST # S-200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3032
Mailing Address - Country:US
Mailing Address - Phone:317-890-5722
Mailing Address - Fax:317-622-1409
Practice Address - Street 1:9670 E WASHINGTON ST # S-200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3032
Practice Address - Country:US
Practice Address - Phone:317-890-5722
Practice Address - Fax:317-622-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040887A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health