Provider Demographics
NPI:1073934055
Name:INTENSIVE INTEGRATION OUTPATIENT CORPORATION
Entity Type:Organization
Organization Name:INTENSIVE INTEGRATION OUTPATIENT CORPORATION
Other - Org Name:INTENSIVE INTEGRATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-424-5659
Mailing Address - Street 1:12300 HUNTERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7524
Mailing Address - Country:US
Mailing Address - Phone:979-690-2220
Mailing Address - Fax:
Practice Address - Street 1:101 E PARK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5483
Practice Address - Country:US
Practice Address - Phone:972-424-5659
Practice Address - Fax:972-424-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3695-3696251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health