Provider Demographics
NPI:1134698434
Name:LIONROCK BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:LIONROCK BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:IAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-994-4990
Mailing Address - Street 1:911 LAKEVILLE ST # 322
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7633 E 63RD PL STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1202
Practice Address - Country:US
Practice Address - Phone:760-994-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIONROCK BEHAVIORAL HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health