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Organization
INNOVATIVE BEHAVIORAL HEALTH SERVICES, LLC
Active
Organization
INNOVATIVE BEHAVIORAL HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCKNER C DENORD (PRESIDENT AND CEO)
(786) 712-2314
Entity
Organization
Contact information
Practice address
26750 S DIXIE HWY, HOMESTEAD, FL 33032-7431
(786) 712-2314
Mailing address
1938 SE 22ND CT, HOMESTEAD, FL 33035-1238
(786) 712-2314
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
684990
—
FL
Enumeration date
09/28/2017
Last updated
06/16/2018
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