Provider Demographics
NPI:1235684663
Name:INSTITUTE OF BEHAVIOR MANAGEMENT
Entity Type:Organization
Organization Name:INSTITUTE OF BEHAVIOR MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEST
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-395-7959
Mailing Address - Street 1:1065 BULLARD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6801
Mailing Address - Country:US
Mailing Address - Phone:919-307-8656
Mailing Address - Fax:919-882-1298
Practice Address - Street 1:1065 BULLARD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6801
Practice Address - Country:US
Practice Address - Phone:919-307-8656
Practice Address - Fax:919-882-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6507251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103509Medicaid