Provider Demographics
NPI:1033474663
Name:INTERACTIONAL PSYCHOTHERAPY INC
Entity Type:Organization
Organization Name:INTERACTIONAL PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOVENER
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV,PHD
Authorized Official - Phone:318-388-8805
Mailing Address - Street 1:300 WASHINGTON ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6714
Mailing Address - Country:US
Mailing Address - Phone:318-388-8805
Mailing Address - Fax:318-388-8813
Practice Address - Street 1:300 WASHINGTON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6714
Practice Address - Country:US
Practice Address - Phone:318-388-8805
Practice Address - Fax:318-388-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty