Provider Demographics
NPI:1134956170
Name:INNERGY BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:INNERGY BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:CLAYDE
Authorized Official - Last Name:LOUALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:832-754-6495
Mailing Address - Street 1:875 NORTH MICHIGAN AVE, 31ST FLOOR STE 3141
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:832-754-6495
Mailing Address - Fax:
Practice Address - Street 1:875 NORTH MICHIGAN AVE, 31ST FLOOR STE 3141
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1771
Practice Address - Country:US
Practice Address - Phone:832-754-6495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health