Provider Demographics
NPI:1144562257
Name:INTEGRATED PSYCHOLOGICAL SERVICES, HAWAII
Entity Type:Organization
Organization Name:INTEGRATED PSYCHOLOGICAL SERVICES, HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-747-5435
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-0326
Mailing Address - Country:US
Mailing Address - Phone:808-747-5435
Mailing Address - Fax:866-384-4779
Practice Address - Street 1:46-3694 PUAONO RD
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-7057
Practice Address - Country:US
Practice Address - Phone:808-747-5435
Practice Address - Fax:866-384-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1374261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73136ZMedicare PIN