Preferred Behavioral Health Mso, Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PREFERRED BEHAVIORAL HEALTH MSO, INC.

Doing business as

Preferred Behavioral Health

Practice address

141 Market PL Ste 100
Fairview Heights, IL 62208-2089

Phone

(618) 398-4226

Fax

(618) 398-1759

NPI assigned

Aug 18, 2020

Organization subpart

No

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

Authorized official

Name

Ryan W Morris

Title

President

Phone

(217) 242-7718

Specialties & licenses 4

Addresses

Other names 2

• PREFERRED BEHAVIORAL HEALTH Doing business as
• ITIC SUPPORT SERVICES, INC. Former legal business name

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1962014472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 MARKET PL STE 100",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082089",
            "telephone_number": "618-398-4226",
            "fax_number": "618-398-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 MARKET PL STE 100",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082089",
            "telephone_number": "618-398-4226",
            "fax_number": "618-398-1759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED BEHAVIORAL HEALTH MSO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-242-7718"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREFERRED BEHAVIORAL HEALTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ITIC SUPPORT SERVICES, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Social Worker in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; 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.