Provider Demographics
NPI:1356673792
Name:INTEGRATED BEAHVIORAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:INTEGRATED BEAHVIORAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST ,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:STEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-765-4509
Mailing Address - Street 1:1621 N 3RD ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3381
Mailing Address - Country:US
Mailing Address - Phone:208-765-4509
Mailing Address - Fax:
Practice Address - Street 1:1621 N 3RD ST STE 1100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3381
Practice Address - Country:US
Practice Address - Phone:208-765-4509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101Y00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003530500Medicaid