Provider Demographics
NPI:1083063044
Name:INNOVATIVE BEHAVIOR INTERVENTIONS
Entity Type:Organization
Organization Name:INNOVATIVE BEHAVIOR INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE-CHAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-413-1487
Mailing Address - Street 1:6229 VILLA RYAN CT
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4723
Mailing Address - Country:US
Mailing Address - Phone:562-413-1487
Mailing Address - Fax:
Practice Address - Street 1:6229 VILLA RYAN CT
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4723
Practice Address - Country:US
Practice Address - Phone:562-413-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health