Provider Demographics
NPI:1184238875
Name:INTEGRATIVE PSYCHOTHERAPY GROUP, A MARRIAGE AND FAMILY THERAPY CORP
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHOTHERAPY GROUP, A MARRIAGE AND FAMILY THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, LPCC
Authorized Official - Phone:310-461-4148
Mailing Address - Street 1:311 N ROBERTSON BLVD STE 718
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1705
Mailing Address - Country:US
Mailing Address - Phone:310-461-4148
Mailing Address - Fax:
Practice Address - Street 1:311 N ROBERTSON BLVD STE 718
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1705
Practice Address - Country:US
Practice Address - Phone:310-461-4148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)