Provider Demographics
NPI:1265027221
Name:IGNITE PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:IGNITE PSYCHOTHERAPY SERVICES
Other - Org Name:IGNITE PSYCHOTHERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-909-0356
Mailing Address - Street 1:5455 SHERIDAN RD STE LL10
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3752
Mailing Address - Country:US
Mailing Address - Phone:262-909-0356
Mailing Address - Fax:
Practice Address - Street 1:5455 SHERIDAN RD STE LL10
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3752
Practice Address - Country:US
Practice Address - Phone:262-909-0356
Practice Address - Fax:262-551-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health