MEDICARE: INTEGRAL PSYCHIATRIC AND RECOVERY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1952985020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRAL PSYCHIATRIC AND RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	14909 LIRI DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-5772
Country	:	US
Telephone Number	:	313-658-6018
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 SHELBY ST STE 700-1003
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-3268
Country	:	US
Telephone Number	:	313-351-9777
Fax Number	:	313-634-9103

Authorized Official
Title or Position	:	PSYCHIATRIST/DIRECTOR
Name	:	JENNIFER ROBINSON
Credential	:	MD
Telephone Number	:	313-658-6018

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	09/28/2021

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