Basic Information
| Provider Information | |||||||||
| NPI: | 1104379882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED PSYCHOLOGICAL SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2780 S JONES BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883202271 | ||||||||
| FaxNumber: | 8887655221 | ||||||||
| Practice Location | |||||||||
| Address1: | 2780 S JONES BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883202271 | ||||||||
| FaxNumber: | 8887655221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2016 | ||||||||
| LastUpdateDate: | 08/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8883205221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY0405 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.