Organization Name: | INTEGRATIVE PSYCHOLOGICAL SERVICES, INC |
NPI Number: | 1205042652 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAWRENCE TODRYK (ADMINISTRATION) |
Mailing Address: | 15 Commerce Dr Suite 113 Grayslake |
State: | IL US |
Postal Code: | 600307807 |
Phone Number: | 2245775308 |
Fax Number: | |
NPI Enumeration Date: | 05/15/2007 |
NPI Last Update Date: | 07/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |