Provider Demographics
NPI:1396386785
Name:INTEGRATED BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:INTEGRATED BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-922-1808
Mailing Address - Street 1:609 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1941
Mailing Address - Country:US
Mailing Address - Phone:810-922-1808
Mailing Address - Fax:
Practice Address - Street 1:8240 EMBURY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7113
Practice Address - Country:US
Practice Address - Phone:810-922-1808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356658579Medicaid