Provider Demographics
NPI:1306387378
Name:INTEGRATIVE BEHAVIORAL HEALTH PARTNERS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE BEHAVIORAL HEALTH PARTNERS, LLC
Other - Org Name:IBHP, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-412-8048
Mailing Address - Street 1:2020 W PINHOOK RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3290
Mailing Address - Country:US
Mailing Address - Phone:337-412-8048
Mailing Address - Fax:
Practice Address - Street 1:2020 W PINHOOK RD
Practice Address - Street 2:SUITE 402
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3290
Practice Address - Country:US
Practice Address - Phone:337-412-8048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty