Healthcare Provider Details

I. General information

NPI: 1114701877
Provider Name (Legal Business Name): INTEGRATED INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 E SHERMAN AVE
COEUR D ALENE ID
83814-4154
US

IV. Provider business mailing address

2482 E GLACIER RD
HAYDEN ID
83835-7793
US

V. Phone/Fax

Practice location:
  • Phone: 208-563-6020
  • Fax: 208-563-6020
Mailing address:
  • Phone: 208-651-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TERRY EDELMANN
Title or Position: FOUNDER CEO
Credential:
Phone: 208-651-0095