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Organization

INNOVATIVE SUPPORT SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STEPHANIE KIRNES MA, CMHP (EXECUTIVE DIRECTOR)
(863) 904-8820
Entity
Organization

Contact information

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

Taxonomy

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

Other

Enumeration date
03/18/2011
Last updated
03/18/2011
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