Provider Demographics
NPI:1205584463
Name:DIVINE INTERVENTION BEHAVIOR THERAPY LLC
Entity type:Organization
Organization Name:DIVINE INTERVENTION BEHAVIOR THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LBSC, MT
Authorized Official - Phone:267-410-0517
Mailing Address - Street 1:642 COWPATH RD STE 382
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1586
Mailing Address - Country:US
Mailing Address - Phone:267-410-0517
Mailing Address - Fax:
Practice Address - Street 1:600 W GERMANTOWN PIKE STE 400
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1046
Practice Address - Country:US
Practice Address - Phone:267-410-0517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health