Provider Demographics
NPI:1508956848
Name:INTEGRATED BODY MIND THERAPY INC
Entity Type:Organization
Organization Name:INTEGRATED BODY MIND THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAIBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:303-875-4033
Mailing Address - Street 1:3000 PEARL ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-875-4033
Mailing Address - Fax:
Practice Address - Street 1:3000 PEARL ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-875-4033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2804103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty