Provider Demographics
NPI:1740549633
Name:INTEGRATED THERAPY SERVICES NW PLLC
Entity type:Organization
Organization Name:INTEGRATED THERAPY SERVICES NW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURDUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:253-460-7248
Mailing Address - Street 1:6004 WESTGATE BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2503
Mailing Address - Country:US
Mailing Address - Phone:253-460-7248
Mailing Address - Fax:253-564-4409
Practice Address - Street 1:6004 WESTGATE BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2503
Practice Address - Country:US
Practice Address - Phone:253-460-7248
Practice Address - Fax:253-564-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty