Provider Demographics
NPI:1770621674
Name:INTEGRATED BEHAVIORAL TECHNOLOGIES INC
Entity type:Organization
Organization Name:INTEGRATED BEHAVIORAL TECHNOLOGIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITZMAN POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-471-7061
Mailing Address - Street 1:1106 N 155TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-7100
Mailing Address - Country:US
Mailing Address - Phone:913-662-7071
Mailing Address - Fax:913-662-7072
Practice Address - Street 1:1106 N 155TH ST STE B
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:913-662-7071
Practice Address - Fax:913-662-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1216103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100643520Medicaid
KS00118206OtherBCBS OF KANSAS
KS37446016OtherBCBS OF KC