Healthcare Provider Details

I. General information

NPI: 1497249767
Provider Name (Legal Business Name): INTEGRATIVE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SNOWHILL ST
SPOTSWOOD NJ
08884-1358
US

IV. Provider business mailing address

14 SNOWHILL ST
SPOTSWOOD NJ
08884-1358
US

V. Phone/Fax

Practice location:
  • Phone: 908-705-6729
  • Fax: 732-837-3062
Mailing address:
  • Phone: 908-705-6729
  • Fax: 732-837-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KHALED REFAI
Title or Position: PRESIDENT
Credential:
Phone: 908-705-6729