Provider Demographics
NPI:1114393162
Name:INTEGRATED BEHAVIORAL HEALTH SOLUTIONS, INC.
Entity Type:Organization
Organization Name:INTEGRATED BEHAVIORAL HEALTH SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALONGI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:813-335-6788
Mailing Address - Street 1:300 10TH ST S
Mailing Address - Street 2:APT #733
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1719
Mailing Address - Country:US
Mailing Address - Phone:813-335-6788
Mailing Address - Fax:
Practice Address - Street 1:300 10TH ST S
Practice Address - Street 2:APT #733
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1719
Practice Address - Country:US
Practice Address - Phone:813-335-6788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014711400Medicaid