Healthcare Provider Details

I. General information

NPI: 1245513894
Provider Name (Legal Business Name): INTEGRATED THERAPY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VALLEY VISTA DR
CAMARILLO CA
93010-1725
US

IV. Provider business mailing address

150 VALLEY VISTA DR
CAMARILLO CA
93010-1725
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-1671
  • Fax: 805-987-0667
Mailing address:
  • Phone: 805-484-1671
  • Fax: 805-987-0667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3002
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP2570
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSP3002
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8110
License Number StateCA

VIII. Authorized Official

Name: MS. ELISABETH CHERYL FLETCHER
Title or Position: PRESIDENT (CEO)
Credential: SLP-CCC, BCBA
Phone: 805-484-1671