Provider Demographics
NPI:1235521303
Name:INTEGRATIVE PSYCHOLOGICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTNIK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-804-4360
Mailing Address - Street 1:4301 EXETER LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1139
Mailing Address - Country:US
Mailing Address - Phone:312-804-4360
Mailing Address - Fax:
Practice Address - Street 1:800 S MILWAUKEE AVE STE 180
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3200
Practice Address - Country:US
Practice Address - Phone:312-804-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006751251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215758Medicare UPIN