Provider Demographics
NPI:1629568225
Name:INTEGRATED HEALTH PSYCHOLOGY
Entity Type:Organization
Organization Name:INTEGRATED HEALTH PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-302-3104
Mailing Address - Street 1:210 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2812
Mailing Address - Country:US
Mailing Address - Phone:248-302-3104
Mailing Address - Fax:
Practice Address - Street 1:210 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-2812
Practice Address - Country:US
Practice Address - Phone:248-302-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty