Provider Demographics
NPI:1053435701
Name:INNOVATIVE ALTERNATIVES, INC.
Entity type:Organization
Organization Name:INNOVATIVE ALTERNATIVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAYUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:713-222-2525
Mailing Address - Street 1:1335 REGENTS PARK DR.
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2541
Mailing Address - Country:US
Mailing Address - Phone:713-222-2525
Mailing Address - Fax:281-480-4815
Practice Address - Street 1:1335 REGENTS PARK DR.
Practice Address - Street 2:SUITE 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2541
Practice Address - Country:US
Practice Address - Phone:713-222-2525
Practice Address - Fax:281-480-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13003251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080221701Medicaid