Healthcare Provider Details

I. General information

NPI: 1730866880
Provider Name (Legal Business Name): INTEGRATED INSIGHT THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MEEKER ST
DELTA CO
81416-1920
US

IV. Provider business mailing address

555 MEEKER ST
DELTA CO
81416-1920
US

V. Phone/Fax

Practice location:
  • Phone: 970-201-1467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: VICKY UBELL
Title or Position: MANAGER
Credential:
Phone: 970-615-0076