Provider Demographics
NPI:1457829913
Name:INTEGRATED THERAPY RESOURCES
Entity Type:Organization
Organization Name:INTEGRATED THERAPY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, RPT
Authorized Official - Phone:402-253-9536
Mailing Address - Street 1:3003 GROVER AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-7020
Mailing Address - Country:US
Mailing Address - Phone:402-253-9536
Mailing Address - Fax:
Practice Address - Street 1:210 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1632
Practice Address - Country:US
Practice Address - Phone:402-253-9536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty