Provider Demographics
NPI:1215300348
Name:IBH INSTITUTE FOR BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:IBH INSTITUTE FOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-665-5339
Mailing Address - Street 1:933 FAIRWAY DR
Mailing Address - Street 2:#203
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3135
Mailing Address - Country:US
Mailing Address - Phone:909-665-5339
Mailing Address - Fax:
Practice Address - Street 1:933 FAIRWAY DR
Practice Address - Street 2:#203
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3135
Practice Address - Country:US
Practice Address - Phone:909-665-5339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty