Healthcare Provider Details

I. General information

NPI: 1255288205
Provider Name (Legal Business Name): INTEGRATIVE THERAPY PRACTICE, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S OAKLAND AVE STE 202
PASADENA CA
91101-2041
US

IV. Provider business mailing address

275 S ARROYO PKWY UNIT 113
PASADENA CA
91105-5210
US

V. Phone/Fax

Practice location:
  • Phone: 310-310-4405
  • Fax:
Mailing address:
  • Phone: 310-310-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY JOSEPH SHACAR
Title or Position: OWNER/DIRECTOR
Credential: PSY.D.
Phone: 310-310-4405