Provider Demographics
NPI:1609501584
Name:INTEGRATIVE BEHAVIORAL HEALTH OF CENTRAL TEXAS
Entity Type:Organization
Organization Name:INTEGRATIVE BEHAVIORAL HEALTH OF CENTRAL TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:254-315-3870
Mailing Address - Street 1:1600 LAKE AIR DR STE 117
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2904
Mailing Address - Country:US
Mailing Address - Phone:254-315-3870
Mailing Address - Fax:
Practice Address - Street 1:1600 LAKE AIR DR STE 117
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2904
Practice Address - Country:US
Practice Address - Phone:254-315-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty