Healthcare Provider Details

I. General information

NPI: 1790964807
Provider Name (Legal Business Name): INTEGRATED PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 NW 41ST ST STE E5
GAINESVILLE FL
32606-6689
US

IV. Provider business mailing address

PO BOX 358742
GAINESVILLE FL
32635-8742
US

V. Phone/Fax

Practice location:
  • Phone: 808-747-5435
  • Fax: 866-384-4779
Mailing address:
  • Phone: 808-747-5435
  • Fax: 866-384-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6767
License Number StateFL

VIII. Authorized Official

Name: DR. JEFFREY GEDNEY
Title or Position: OWNER
Credential: PSYD
Phone: 808-747-5435