Healthcare Provider Details

I. General information

NPI: 1184807299
Provider Name (Legal Business Name): INTEGRATIVE EDUCATIONAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6739 COURTLAND DR NE SUITE 101
ROCKFORD MI
49341-7216
US

IV. Provider business mailing address

6739 COURTLAND DR NE SUITE 101
ROCKFORD MI
49341-7216
US

V. Phone/Fax

Practice location:
  • Phone: 616-874-7490
  • Fax: 847-770-4772
Mailing address:
  • Phone: 616-874-7490
  • Fax: 847-770-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateMI

VIII. Authorized Official

Name: JULIE ANN BILLETT
Title or Position: OWNER
Credential: NP
Phone: 616-874-7490