Provider Demographics
NPI:1649744525
Name:INDEPENDENCE BEHAVIOR SOLUTIONS
Entity type:Organization
Organization Name:INDEPENDENCE BEHAVIOR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-560-6622
Mailing Address - Street 1:5203 MARYLAND WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5022
Mailing Address - Country:US
Mailing Address - Phone:615-560-6622
Mailing Address - Fax:
Practice Address - Street 1:2451B US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3397
Practice Address - Country:US
Practice Address - Phone:615-560-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency