Provider Demographics
NPI:1114344074
Name:INTEGRATIVE PSYCHOLOGICAL AND SOCIAL SERVICES
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL AND SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, PSYD
Authorized Official - Phone:360-348-0205
Mailing Address - Street 1:5019 GROVE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270
Mailing Address - Country:US
Mailing Address - Phone:360-348-0205
Mailing Address - Fax:360-691-9887
Practice Address - Street 1:5019 GROVE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4487
Practice Address - Country:US
Practice Address - Phone:360-348-0205
Practice Address - Fax:360-691-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60425258101Y00000X
WALH60412214101YM0800X
WAPY60195906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty