Provider Demographics
NPI:1710185475
Name:IBG ENTERPRISES, INC.
Entity Type:Organization
Organization Name:IBG ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GIESSL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:513-221-2001
Mailing Address - Street 1:9900 CARVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5523
Mailing Address - Country:US
Mailing Address - Phone:513-221-2001
Mailing Address - Fax:513-961-7444
Practice Address - Street 1:9900 CARVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5523
Practice Address - Country:US
Practice Address - Phone:513-221-2001
Practice Address - Fax:513-961-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0800459Medicaid
OH386448939-00OtherBWC - PSYCHOLOGIST
OHGICP01681Medicare ID - Type UnspecifiedPSYCHOLOGIST