Provider Demographics
NPI:1417355504
Name:INTEGRATIVE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:205-427-6032
Mailing Address - Street 1:500 SOUTHLAND DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226
Mailing Address - Country:US
Mailing Address - Phone:205-427-6032
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTHLAND DRIVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226
Practice Address - Country:US
Practice Address - Phone:205-427-6032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1140-3596C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty