Provider Demographics
NPI:1033275458
Name:INTEGRATIVE PSYCHIATRY, P.C.
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-338-1040
Mailing Address - Street 1:3701 W 49TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4241
Mailing Address - Country:US
Mailing Address - Phone:605-338-1040
Mailing Address - Fax:605-338-1102
Practice Address - Street 1:3701 W 49TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4241
Practice Address - Country:US
Practice Address - Phone:605-338-1040
Practice Address - Fax:605-338-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD51992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD41409Medicare ID - Type UnspecifiedGROUP NUMBER