Innovative Behavioral Health LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

4216 Issued in OK

Legal business name

INNOVATIVE BEHAVIORAL HEALTH LLC

Practice address

2370 S Kerr Blvd
Sallisaw, OK 74955-7031

Phone

(479) 461-5275

NPI assigned

Jan 25, 2016

Last updated

Jan 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Bourne, LPC

Title

Owner

Phone

(479) 461-5275

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453680000000",
    "number": "1649637422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 S 54TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034617",
            "telephone_number": "479-461-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2370 S KERR BLVD",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749557031",
            "telephone_number": "479-461-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-01-25",
        "status": "A",
        "authorized_official_last_name": "BOURNE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-461-5275",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OK",
            "license": "4216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Sallisaw, OK
• Providers in Sallisaw, OK by specialty
• Community/Behavioral Health Agency in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.