Provider Demographics
NPI:1942879218
Name:POSITIVE INTERVENTION PEDIATRIC BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:POSITIVE INTERVENTION PEDIATRIC BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS-BRINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:641-895-5559
Mailing Address - Street 1:209 E MAPLE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-2200
Mailing Address - Country:US
Mailing Address - Phone:641-895-5559
Mailing Address - Fax:
Practice Address - Street 1:209 E MAPLE ST STE 3
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-2200
Practice Address - Country:US
Practice Address - Phone:641-895-5559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty