Basic Information
| Provider Information | |||||||||
| NPI: | 1629568225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED HEALTH PSYCHOLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 CROOKS RD | ||||||||
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| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480734049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483023104 | ||||||||
| FaxNumber: | 7342075326 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 BRADLEY ST | ||||||||
| Address2: | |||||||||
| City: | COMMERCE TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483822812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483023104 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | ELWELL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | LLP/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2483023104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LLP | ||||||||
| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301014559 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.