Provider Demographics
NPI:1093987240
Name:INNOVATIVE THERAPEUTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:LYNTRICE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC, SAP
Authorized Official - Phone:313-658-3346
Mailing Address - Street 1:PO BOX 44805
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0805
Mailing Address - Country:US
Mailing Address - Phone:313-964-2648
Mailing Address - Fax:866-468-9584
Practice Address - Street 1:155 W. CONGRESS ST.
Practice Address - Street 2:SUITE 306
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3272
Practice Address - Country:US
Practice Address - Phone:313-964-2648
Practice Address - Fax:866-468-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089872251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI9294Medicare PIN