Provider Demographics
NPI:1073005856
Name:ARBOR INTEGRATIVE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ARBOR INTEGRATIVE BEHAVIORAL HEALTH
Other - Org Name:ARBOR
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:612-910-9919
Mailing Address - Street 1:5433 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-9720
Mailing Address - Country:US
Mailing Address - Phone:612-910-9919
Mailing Address - Fax:218-722-0600
Practice Address - Street 1:1000 E 1ST ST STE 105
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-1122
Practice Address - Fax:218-722-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5778261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty