Provider Demographics
NPI:1093367633
Name:INNOVATIVE BEHAVIORAL MEDICINE LLC
Entity Type:Organization
Organization Name:INNOVATIVE BEHAVIORAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOISSE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:724-984-8645
Mailing Address - Street 1:201 PENN CENTER BLVD STE 457
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5435
Mailing Address - Country:US
Mailing Address - Phone:412-439-1251
Mailing Address - Fax:412-291-3003
Practice Address - Street 1:201 PENN CENTER BLVD STE 457
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5435
Practice Address - Country:US
Practice Address - Phone:412-439-1251
Practice Address - Fax:412-291-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty