Provider Demographics
NPI:1831207463
Name:INTEGRAL LIFE SYSTEMS INC
Entity type:Organization
Organization Name:INTEGRAL LIFE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-336-2428
Mailing Address - Street 1:11732 FEINBERG PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1561
Mailing Address - Country:US
Mailing Address - Phone:702-336-2428
Mailing Address - Fax:702-562-2428
Practice Address - Street 1:2580 MONTESSOURI ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3066
Practice Address - Country:US
Practice Address - Phone:702-947-4749
Practice Address - Fax:702-256-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS176901041C0700X
NV4910-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184633349OtherINDIVIDUAL NPI AS AN LCSW