Provider Demographics
NPI:1871975680
Name:INNOVATIVE BEHAVIORAL SOLUTIONS INC
Entity type:Organization
Organization Name:INNOVATIVE BEHAVIORAL SOLUTIONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, LBA
Authorized Official - Phone:702-485-6705
Mailing Address - Street 1:5828 SPRING MOUNTAIN RD STE 318
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8896
Mailing Address - Country:US
Mailing Address - Phone:702-485-6705
Mailing Address - Fax:702-485-6706
Practice Address - Street 1:5828 SPRING MOUNTAIN RD STE 318
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8896
Practice Address - Country:US
Practice Address - Phone:702-485-6705
Practice Address - Fax:702-485-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0041103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV103K00000XMedicaid