Provider Demographics
NPI:1134587017
Name:INTEGRATIVE PSYCHOLOGICAL HEALTH, LLC
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-915-6515
Mailing Address - Street 1:26777 LORAIN RD STE 412
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3224
Mailing Address - Country:US
Mailing Address - Phone:216-801-4656
Mailing Address - Fax:216-767-5900
Practice Address - Street 1:26777 LORAIN RD STE 412
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3224
Practice Address - Country:US
Practice Address - Phone:216-801-4656
Practice Address - Fax:216-767-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6890261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health