Provider Demographics
NPI:1003275660
Name:INTEGRATIVE PSYCHOTHERAPY INSTITUTE
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOTHERAPY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-244-6298
Mailing Address - Street 1:3615 CHAIN BRIDGE RD STE I
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3237
Mailing Address - Country:US
Mailing Address - Phone:703-385-9667
Mailing Address - Fax:
Practice Address - Street 1:3615 CHAIN BRIDGE RD STE I
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3237
Practice Address - Country:US
Practice Address - Phone:703-385-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00042251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health