Provider Demographics
NPI:1700484599
Name:INSTITUTE OF INTRAPERSONAL DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:INSTITUTE OF INTRAPERSONAL DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERISHA
Authorized Official - Middle Name:LACRAE
Authorized Official - Last Name:RUTLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-625-6070
Mailing Address - Street 1:1872 WOODHOLLOW DRIVE
Mailing Address - Street 2:APT. 211
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3957
Mailing Address - Country:US
Mailing Address - Phone:314-625-6070
Mailing Address - Fax:
Practice Address - Street 1:1872 WOODHOLLOW DRIVE
Practice Address - Street 2:APT. 211
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3957
Practice Address - Country:US
Practice Address - Phone:314-625-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health