Organization Active NPI

Motivational Institute for Behavioral Health, LLC

  • Clinical Psychologist
  • Fort Lauderdale, FL
National Provider Identifier
1265765242
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY7732 Issued in FL
Legal business name
MOTIVATIONAL INSTITUTE FOR BEHAVIORAL HEALTH, LLC
Practice address
1421 SE 4TH Ave FL 1
Fort Lauderdale, FL 33316-1900
Phone
(954) 616-5088
Fax
(954) 616-5147
NPI assigned
Sep 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lori Lenay Eickleberry, PH.D.NPI 1669632931
Title
Licensed Psychologist
Phone
(954) 315-1774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PY7732 FL Primary

Addresses

Primary practice location

1421 SE 4TH Ave FL 1
Fort Lauderdale, FL 33316-1900

Mailing address

1421 SE 4TH Ave FL 1
Fort Lauderdale, FL 33316-1900
Phone (954) 616-5088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100503000838 FL Part B Supplier - Clinic/Group Practice 4486782067 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Lauderdale, FL

National Provider Directory

National Provider Directory

Locations

2881 E Oakland Park Blvd
Ste 313
Fort Lauderdale, FL 33306
Phone (954) 315-1774

1421 SE 4th Ave
Fl 1
Fort Lauderdale, FL 33316
Phone (954) 616-5088

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699228800000",
    "number": "1265765242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 SE 4TH AVE FL 1",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161900",
            "telephone_number": "954-616-5088",
            "fax_number": "954-616-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 SE 4TH AVE FL 1",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161900",
            "telephone_number": "954-616-5088",
            "fax_number": "954-616-5147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOTIVATIONAL INSTITUTE FOR BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-09",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "EICKLEBERRY",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "LENAY",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "954-315-1774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.