Healthcare Provider Details

I. General information

NPI: 1245370923
Provider Name (Legal Business Name): INTEGRITY LIFESKILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BREMOND ST 506
VERSAILLES MO
65084
US

IV. Provider business mailing address

PO BOX 232
VERSAILLES MO
65084
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-6768
  • Fax: 573-378-6768
Mailing address:
  • Phone: 573-378-6768
  • Fax: 573-378-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM NORMAN GEARY
Title or Position: CO OWNERS
Credential:
Phone: 573-378-6768