Provider Demographics
NPI:1356011217
Name:PACIFIC INTEGRATIVE THERAPY INC
Entity Type:Organization
Organization Name:PACIFIC INTEGRATIVE THERAPY INC
Other - Org Name:GREEN PSYCHOLOGICAL SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEDIEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZADMEHR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-877-1750
Mailing Address - Street 1:12636 HIGH BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2022
Mailing Address - Country:US
Mailing Address - Phone:858-877-1860
Mailing Address - Fax:
Practice Address - Street 1:12636 HIGH BLUFF DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2022
Practice Address - Country:US
Practice Address - Phone:858-877-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty