Provider Demographics
NPI:1790964807
Name:INTEGRATED PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATED PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-747-5435
Mailing Address - Street 1:PO BOX 358742
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-8742
Mailing Address - Country:US
Mailing Address - Phone:808-747-5435
Mailing Address - Fax:866-384-4779
Practice Address - Street 1:2631 NW 41ST ST STE E5
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6689
Practice Address - Country:US
Practice Address - Phone:808-747-5435
Practice Address - Fax:866-384-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9478Medicare PIN