Provider Demographics
NPI:1205201209
Name:INSTITUTE FOR BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:INSTITUTE FOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE SUPERIVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LONI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-590-5764
Mailing Address - Street 1:12223 CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4450
Mailing Address - Country:US
Mailing Address - Phone:760-590-5764
Mailing Address - Fax:
Practice Address - Street 1:12223 CUSTER ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4450
Practice Address - Country:US
Practice Address - Phone:760-590-5764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty