Provider Demographics
NPI:1528417524
Name:INNOVATIVE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:INNOVATIVE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-324-7366
Mailing Address - Street 1:1001 LAKE FOREST BOULEVARD
Mailing Address - Street 2:SUITE 607
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-6201
Mailing Address - Country:US
Mailing Address - Phone:504-324-7366
Mailing Address - Fax:504-324-3849
Practice Address - Street 1:10001 LAKE FOREST BLVD
Practice Address - Street 2:SUITE 607
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6200
Practice Address - Country:US
Practice Address - Phone:504-324-7366
Practice Address - Fax:504-324-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health