Healthcare Provider Details

I. General information

NPI: 1831428341
Provider Name (Legal Business Name): INTEGRATIVE HEALTH RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 W 96TH ST STE 220
INDIANAPOLIS IN
46268-2916
US

IV. Provider business mailing address

3802 W 96TH ST STE 220
INDIANAPOLIS IN
46268-2916
US

V. Phone/Fax

Practice location:
  • Phone: 317-471-8780
  • Fax: 317-471-8782
Mailing address:
  • Phone: 317-471-8780
  • Fax: 317-471-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number34003862A
License Number StateIN

VIII. Authorized Official

Name: MR. ALLEN MARCELLUS RADER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 317-471-8780