Provider Demographics
NPI:1669899431
Name:INTEGRATIVE THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:INTEGRATIVE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CERTIFIED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-201-6165
Mailing Address - Street 1:2460 TERRY RD STE 800
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-5769
Mailing Address - Country:US
Mailing Address - Phone:601-201-6165
Mailing Address - Fax:601-923-0061
Practice Address - Street 1:2460 TERRY RD STE 800
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-5769
Practice Address - Country:US
Practice Address - Phone:601-201-6165
Practice Address - Fax:601-923-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07570361Medicaid