Provider Demographics
NPI:1982308045
Name:INTEGRATED INSIGHT THERAPY, LLC
Entity Type:Organization
Organization Name:INTEGRATED INSIGHT THERAPY, LLC
Other - Org Name:CORTEZ LOCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING / BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:UBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-615-0076
Mailing Address - Street 1:555 MEEKER ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1920
Mailing Address - Country:US
Mailing Address - Phone:970-201-1467
Mailing Address - Fax:970-399-3648
Practice Address - Street 1:136 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3510
Practice Address - Country:US
Practice Address - Phone:970-201-1467
Practice Address - Fax:970-399-3648
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED INSIGHT THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty