Provider Demographics
NPI:1134812134
Name:ADVANCED BEHAVIORAL HEALTH SERVICES OF TIFTON
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL HEALTH SERVICES OF TIFTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-242-0122
Mailing Address - Street 1:16 LIBRARY LN
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4415
Mailing Address - Country:US
Mailing Address - Phone:229-396-5885
Mailing Address - Fax:
Practice Address - Street 1:16 LIBRARY LN
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4415
Practice Address - Country:US
Practice Address - Phone:229-396-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health