Healthcare Provider Details

I. General information

NPI: 1225787682
Provider Name (Legal Business Name): INTEGRAL PSYCHIATRY & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5464 N PALM AVE STE B
FRESNO CA
93704-1946
US

IV. Provider business mailing address

5464 N PALM AVE STE B
FRESNO CA
93704-1946
US

V. Phone/Fax

Practice location:
  • Phone: 559-943-3078
  • Fax:
Mailing address:
  • Phone: 559-943-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYLENE BOOTH
Title or Position: BILLING
Credential:
Phone: 805-441-8398