Provider Demographics
NPI:1639793888
Name:INTEGRATIVE BEHAVIORAL HEALTH AND ALTERNATIVE HEALING ARTS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE BEHAVIORAL HEALTH AND ALTERNATIVE HEALING ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JANELLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-313-2988
Mailing Address - Street 1:117 E 18TH ST # 141
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3752
Mailing Address - Country:US
Mailing Address - Phone:270-313-2988
Mailing Address - Fax:
Practice Address - Street 1:1727 SWEENEY ST STE 102
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3834
Practice Address - Country:US
Practice Address - Phone:270-313-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)