Basic Information
| Provider Information | |||||||||
| NPI: | 1770621674 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED BEHAVIORAL TECHNOLOGIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 N 155TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | BASEHOR | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660077100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136627071 | ||||||||
| FaxNumber: | 9136627072 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 N 155TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | BASEHOR | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660077100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136627071 | ||||||||
| FaxNumber: | 9136627072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | HEITZMAN POWELL | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9134717061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | LP1216 | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
ID Information
| ID | Type | State | Issuer | Description | 100643520 | 05 | KS | MEDICAID | 00118206 | 01 | KS | BCBS OF KANSAS | OTHER | 37446016 | 01 | KS | BCBS OF KC | OTHER |