Provider Demographics
NPI:1033834395
Name:INTEGRAL PIECES, LLC
Entity Type:Organization
Organization Name:INTEGRAL PIECES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:CUSTER
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:863-660-7698
Mailing Address - Street 1:1524 E NORTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2424
Mailing Address - Country:US
Mailing Address - Phone:863-660-7698
Mailing Address - Fax:
Practice Address - Street 1:190 FITZGERALD RD STE 1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2620
Practice Address - Country:US
Practice Address - Phone:863-320-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health