Provider Demographics
NPI:1437566023
Name:INNER CITY BEHAVIOR SERVICES, LLC
Entity type:Organization
Organization Name:INNER CITY BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:II
Authorized Official - Credentials:CSAC
Authorized Official - Phone:414-445-8721
Mailing Address - Street 1:3897 N 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3063
Mailing Address - Country:US
Mailing Address - Phone:414-445-8721
Mailing Address - Fax:414-455-3292
Practice Address - Street 1:3020 W VLIET ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2461
Practice Address - Country:US
Practice Address - Phone:414-445-8721
Practice Address - Fax:414-455-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)