Provider Demographics
NPI:1124493192
Name:INSTITUTE FOR BEHAVIOR HEALTH (IBH)
Entity type:Organization
Organization Name:INSTITUTE FOR BEHAVIOR HEALTH (IBH)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA EDU
Authorized Official - Phone:323-793-3237
Mailing Address - Street 1:2295 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1252
Mailing Address - Country:US
Mailing Address - Phone:323-793-3237
Mailing Address - Fax:
Practice Address - Street 1:401 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-435-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty