Provider Demographics
NPI:1376306951
Name:INTEGRATIVE PSYCHOTHERAPY CENTER
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LATHY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:213-422-9929
Mailing Address - Street 1:1008 E 3RD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3442
Mailing Address - Country:US
Mailing Address - Phone:213-422-9929
Mailing Address - Fax:
Practice Address - Street 1:1008 E 3RD ST APT 10
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3442
Practice Address - Country:US
Practice Address - Phone:213-422-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty