Provider Demographics
NPI:1023391885
Name:INTEGRATED MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:INTEGRATED MENTAL HEALTH SERVICES
Other - Org Name:CENPATICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PSYCHOLOGIST
Authorized Official - Phone:512-406-7515
Mailing Address - Street 1:504 LAVACA STREET
Mailing Address - Street 2:SUITE 850
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2939
Mailing Address - Country:US
Mailing Address - Phone:512-406-7200
Mailing Address - Fax:
Practice Address - Street 1:504 LAVACA STREET
Practice Address - Street 2:SUITE 850
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2939
Practice Address - Country:US
Practice Address - Phone:512-406-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization