# INNOVATIVE SUPPORT SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184923054
- **Authorized official:** STEPHANIE KIRNES MA, CMHP (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (863) 904-8820

## Contact information

- **Practice address:** 310 MODEST ST, LAKELAND, FL 33805-3123
- **Practice address phone:** (863) 904-8820
- **Practice address fax:** (866) 271-5349
- **Mailing address:** PO BOX 2253, EATON PARK, FL 33840-2253
- **Mailing address phone:** (863) 904-8820
- **Mailing address fax:** (866) 271-5349

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | Yes |
| 251K00000X | Public Health or Welfare Agency | — | NULL | — |
| 251X00000X | Supports Brokerage Agency | — | NULL | — |

## Other

- **Enumeration date:** 03/18/2011
- **Last updated:** 03/18/2011