Healthcare Provider Details

I. General information

NPI: 1073578431
Provider Name (Legal Business Name): INTEGRATED SERVICES FOR BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MOUNT SAINT MARYS DR
NELSONVILLE OH
45764-1280
US

IV. Provider business mailing address

PO BOX 132
ATHENS OH
45701-0132
US

V. Phone/Fax

Practice location:
  • Phone: 740-644-9872
  • Fax: 833-733-8327
Mailing address:
  • Phone: 740-644-9872
  • Fax: 833-733-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA SHAFER
Title or Position: CEO
Credential: LISW-S
Phone: 740-644-9872