Organization
INNOVATE BEHAVIORAL HEALTH MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY HTEWLAY KHIN MD (OWNER)
(909) 579-2555
Entity
Organization
Contact information
Practice address
732 N MOUNTAIN AVE STE A, UPLAND, CA 91786-4372
(909) 579-2555
(909) 579-2118
Mailing address
732 N MOUNTAIN AVE STE A, UPLAND, CA 91786-4372
(909) 727-8225
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Enumeration date
06/24/2020
Last updated
02/17/2023
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