Provider Demographics
NPI:1437923968
Name:INTEGRATIVE MIND AND BODY SERVICES
Entity Type:Organization
Organization Name:INTEGRATIVE MIND AND BODY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-955-5479
Mailing Address - Street 1:300 MULBERRY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1233
Mailing Address - Country:US
Mailing Address - Phone:570-955-5479
Mailing Address - Fax:570-955-5528
Practice Address - Street 1:300 MULBERRY ST STE 201
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1233
Practice Address - Country:US
Practice Address - Phone:570-955-5479
Practice Address - Fax:570-955-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty