Provider Demographics
NPI:1265765242
Name:MOTIVATIONAL INSTITUTE FOR BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:MOTIVATIONAL INSTITUTE FOR BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LENAY
Authorized Official - Last Name:EICKLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-315-1774
Mailing Address - Street 1:1421 SE 4TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1900
Mailing Address - Country:US
Mailing Address - Phone:954-616-5088
Mailing Address - Fax:954-616-5147
Practice Address - Street 1:1421 SE 4TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1900
Practice Address - Country:US
Practice Address - Phone:954-616-5088
Practice Address - Fax:954-616-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty