Provider Demographics
NPI:1144417361
Name:INTENTIONAL ALTERNATIVES LLC
Entity Type:Organization
Organization Name:INTENTIONAL ALTERNATIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THIALIAANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARLETT-LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:314-656-6293
Mailing Address - Street 1:11650 NEW HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6924
Mailing Address - Country:US
Mailing Address - Phone:314-656-6293
Mailing Address - Fax:314-584-2171
Practice Address - Street 1:11650 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6924
Practice Address - Country:US
Practice Address - Phone:314-656-6293
Practice Address - Fax:314-584-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2020-10-05
Deactivation Date:2020-09-25
Deactivation Code:
Reactivation Date:2020-09-30
Provider Licenses
StateLicense IDTaxonomies
MO2002032320101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty