Provider Demographics
NPI:1306211180
Name:INNOVATIVE BEHAVIOR SERVICES
Entity Type:Organization
Organization Name:INNOVATIVE BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERNEKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:901-491-6653
Mailing Address - Street 1:7119 BRISTOL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4289
Mailing Address - Country:US
Mailing Address - Phone:901-491-6653
Mailing Address - Fax:
Practice Address - Street 1:7119 BRISTOL MEADOW LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4289
Practice Address - Country:US
Practice Address - Phone:901-491-6653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN208D00000XOtherOTHER NON SPECIFIED