Provider Demographics
NPI:1427395714
Name:INTEGRATIVE HEALTH ALLIANCE
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHICPHYSICIAN/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUKOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, EAMP
Authorized Official - Phone:360-863-2152
Mailing Address - Street 1:611 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2415
Mailing Address - Country:US
Mailing Address - Phone:360-863-2152
Mailing Address - Fax:
Practice Address - Street 1:209 AVENUE D
Practice Address - Street 2:SUITE 100B
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290
Practice Address - Country:US
Practice Address - Phone:360-863-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60267372171100000X
WANT60264357175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty