Healthcare Provider Details

I. General information

NPI: 1164001152
Provider Name (Legal Business Name): INTEGRATIVE THERAPY SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 SOUTH JACKSON STREET #211
DENVER CO
80210
US

IV. Provider business mailing address

9609 S UNIVERSITY BLVD UNIT 630015
HIGHLANDS RANCH CO
80163-3000
US

V. Phone/Fax

Practice location:
  • Phone: 720-334-1864
  • Fax: 720-230-5072
Mailing address:
  • Phone: 720-334-1864
  • Fax: 720-230-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RODERIC A BURKS
Title or Position: ONWER - CINICAL DIRECTOR
Credential: MA, MS HSC, MS, LPC
Phone: 720-334-1864