Provider Demographics
NPI:1114701877
Name:INTEGRATED INTERVENTIONS
Entity Type:Organization
Organization Name:INTEGRATED INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-651-0095
Mailing Address - Street 1:2482 E GLACIER RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7793
Mailing Address - Country:US
Mailing Address - Phone:208-651-0095
Mailing Address - Fax:
Practice Address - Street 1:1103 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4154
Practice Address - Country:US
Practice Address - Phone:208-563-6020
Practice Address - Fax:208-563-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty