Provider Demographics
NPI:1104457720
Name:ALLIANCE BEHAVIORAL HEALTH INC. LLC
Entity type:Organization
Organization Name:ALLIANCE BEHAVIORAL HEALTH INC. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:937-738-7350
Mailing Address - Street 1:1961 BOBTAIL LN
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7020
Mailing Address - Country:US
Mailing Address - Phone:937-738-7350
Mailing Address - Fax:804-918-3062
Practice Address - Street 1:1961 BOBTAIL LN
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7020
Practice Address - Country:US
Practice Address - Phone:937-738-7350
Practice Address - Fax:804-918-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health