Provider Demographics
NPI:1144610965
Name:INNOVATIVE BEHAVIOR OPTIONS
Entity Type:Organization
Organization Name:INNOVATIVE BEHAVIOR OPTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-992-8534
Mailing Address - Street 1:4617 PATRICK DR NE
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4617 PATRICK DR NE
Practice Address - Street 2:ROSWELL
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1640
Practice Address - Country:US
Practice Address - Phone:404-907-5821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA103K00000XOtherBEHAVIOR ANALYSIS