Provider Demographics
NPI:1437515442
Name:INTEGRATIVE PSYCHOLOGICAL AND SOCIAL SERVICES
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL AND SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDMONDS DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-678-0463
Mailing Address - Street 1:21701 76TH AVE W
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-678-0463
Mailing Address - Fax:425-678-0591
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:SUITE 302
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-678-0463
Practice Address - Fax:425-678-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60195906103TC0700X
WAPY60598436251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty