Provider Demographics
NPI:1598874414
Name:INTEGRATED BEHAVIORAL HEALTHCARE MANAGEMENT SERVICES, INC.
Entity Type:Organization
Organization Name:INTEGRATED BEHAVIORAL HEALTHCARE MANAGEMENT SERVICES, INC.
Other - Org Name:HUNTINGDON COUNSELING AND PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:814-643-6300
Mailing Address - Street 1:900 BRYAN STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652
Mailing Address - Country:US
Mailing Address - Phone:814-643-6300
Mailing Address - Fax:814-643-8776
Practice Address - Street 1:900 BRYAN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2413
Practice Address - Country:US
Practice Address - Phone:814-643-6300
Practice Address - Fax:814-643-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA313180261Q00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1359155OtherBLUE SHIELD
PA100746486Medicaid
PA1350119OtherBLUE SHIELD (MANAGED CARE