Innovative Behavioral Concepts LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

INNOVATIVE BEHAVIORAL CONCEPTS LLC

Practice address

104 Centre Blvd Ste a
Marlton, NJ 08053-4130

Phone

(856) 258-7464

NPI assigned

Feb 23, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Elrita Godbold, LCSWNPI 1699900639

Title

Clinical Director

Phone

(856) 258-7464

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elrita Michelle Godbold, LCSW

  • Mental Health Counselor
  • Marlton, NJ
  • NPI 1699900639
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1306592894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CENTRE BLVD STE A",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534130",
            "telephone_number": "856-258-7464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CENTRE BLVD STE A",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534130",
            "telephone_number": "856-258-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE BEHAVIORAL CONCEPTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "GODBOLD",
        "authorized_official_first_name": "ELRITA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "856-258-7464",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Innovativebehavioralconcepts2021@gmail.com",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "104 Centre Blvd Ste B",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080534130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Community/Behavioral Health Agency in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Community/Behavioral Health Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.