Provider Demographics
NPI:1720204787
Name:INTEGRATIVE HEALTH PARTNERS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-263-8034
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-263-8034
Mailing Address - Fax:312-263-2289
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1008
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-263-8034
Practice Address - Fax:312-263-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty