Provider Demographics
NPI:1295073393
Name:INTEGRATED BEHAVIORAL HEALTH PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:INTEGRATED BEHAVIORAL HEALTH PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZOWSKI-SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH,PHD
Authorized Official - Phone:269-459-1512
Mailing Address - Street 1:5380 HOLIDAY TER
Mailing Address - Street 2:SUITE #32
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2154
Mailing Address - Country:US
Mailing Address - Phone:269-459-1512
Mailing Address - Fax:269-459-1514
Practice Address - Street 1:5380 HOLIDAY TER
Practice Address - Street 2:SUITE #32
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2154
Practice Address - Country:US
Practice Address - Phone:269-459-1512
Practice Address - Fax:269-459-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty