Healthcare Provider Details

I. General information

NPI: 1891699690
Provider Name (Legal Business Name): INTEGRATED BEHAVIORAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3591 S MERCY RD STE 204
GILBERT AZ
85297-2240
US

IV. Provider business mailing address

1455 N GAYLORD CIR
MESA AZ
85213-4120
US

V. Phone/Fax

Practice location:
  • Phone: 623-974-2673
  • Fax:
Mailing address:
  • Phone: 480-203-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAINA STAPLEY
Title or Position: CEO
Credential: MBA
Phone: 480-203-5501