Provider Demographics
NPI:1740619337
Name:PITTSBURGH INTEGRATIVE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:PITTSBURGH INTEGRATIVE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-687-1234
Mailing Address - Street 1:160 N CRAIG ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2716
Mailing Address - Country:US
Mailing Address - Phone:412-687-1234
Mailing Address - Fax:
Practice Address - Street 1:160 N CRAIG ST
Practice Address - Street 2:SUITE 212
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2716
Practice Address - Country:US
Practice Address - Phone:412-687-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty