Provider Demographics
NPI:1417596123
Name:LEXINTEGRATIVE PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:LEXINTEGRATIVE PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:SOPHIS
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-855-7633
Mailing Address - Street 1:807 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3907
Mailing Address - Country:US
Mailing Address - Phone:617-855-7633
Mailing Address - Fax:
Practice Address - Street 1:807 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3907
Practice Address - Country:US
Practice Address - Phone:617-855-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health