Basic Information
| Provider Information | |||||||||
| NPI: | 1477764850 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTEGRITY THERAPEUTIC SERVICES | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783 | ||||||||
| Address2: | |||||||||
| City: | WEISER | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836720783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085500834 | ||||||||
| FaxNumber: | 2085493725 | ||||||||
| Practice Location | |||||||||
| Address1: | 1818 S 10TH AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CALDWELL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836054803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084594412 | ||||||||
| FaxNumber: | 2084547296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANDERS | ||||||||
| AuthorizedOfficialFirstName: | LORINDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2085500834 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.