Provider Demographics
NPI:1750786026
Name:INTEGRATIVE PSYCHOLOGY, INC
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-455-5831
Mailing Address - Street 1:112 HARVARD AVE
Mailing Address - Street 2:# 3
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4716
Mailing Address - Country:US
Mailing Address - Phone:909-455-5831
Mailing Address - Fax:855-295-3087
Practice Address - Street 1:260 S LOS ROBLES AVE
Practice Address - Street 2:# 311
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2824
Practice Address - Country:US
Practice Address - Phone:909-455-5831
Practice Address - Fax:855-295-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty