Basic Information
| Provider Information | |||||||||
| NPI: | 1740549633 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED THERAPY SERVICES NW PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6004 WESTGATE BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984062503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
| FaxNumber: | 2535644409 | ||||||||
| Practice Location | |||||||||
| Address1: | 6004 WESTGATE BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984062503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
| FaxNumber: | 2535644409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2012 | ||||||||
| LastUpdateDate: | 05/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | PURDUM | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2534607248 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LF00001770 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.