Healthcare Provider Details

I. General information

NPI: 1285982660
Provider Name (Legal Business Name): INTEGRATED TREATMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14362 N FRANK LLOYD WRIGHT BLVD SUITE B111
SCOTTSDALE AZ
85260-8846
US

IV. Provider business mailing address

14362 N FRANK LLOYD WRIGHT BLVD SUITE B111
SCOTTSDALE AZ
85260-8846
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-8367
  • Fax: 480-383-6996
Mailing address:
  • Phone: 480-788-8367
  • Fax: 480-383-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number005284
License Number StateAZ

VIII. Authorized Official

Name: MR. KENDRIC BURTON SPEAGLE
Title or Position: CEO
Credential:
Phone: 480-612-4889