Healthcare Provider Details

I. General information

NPI: 1316461007
Provider Name (Legal Business Name): INTEGRATED HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 WOODS EDGE DR
ALEXANDRIA LA
71303-7130
US

IV. Provider business mailing address

PO BOX 13566
ALEXANDRIA LA
71315-3566
US

V. Phone/Fax

Practice location:
  • Phone: 318-446-0231
  • Fax: 318-446-0231
Mailing address:
  • Phone: 318-446-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN COOPER
Title or Position: MANAGER
Credential:
Phone: 318-446-0231