Basic Information
| Provider Information | |||||||||
| NPI: | 1841469947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATIVE FAMILY & THERAPY SERVICES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 641 S HILLSIDE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672113001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166842422 | ||||||||
| FaxNumber: | 3166841210 | ||||||||
| Practice Location | |||||||||
| Address1: | 641 S HILLSIDE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672113001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166842422 | ||||||||
| FaxNumber: | 3166841210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 02/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEBER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3166842422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 074 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.