Healthcare Provider Details

I. General information

NPI: 1134587017
Provider Name (Legal Business Name): INTEGRATIVE PSYCHOLOGICAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD STE 412
NORTH OLMSTED OH
44070-3224
US

IV. Provider business mailing address

26777 LORAIN RD STE 412
NORTH OLMSTED OH
44070-3224
US

V. Phone/Fax

Practice location:
  • Phone: 216-801-4656
  • Fax: 216-767-5900
Mailing address:
  • Phone: 216-801-4656
  • Fax: 216-767-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6890
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6890
License Number StateOH

VIII. Authorized Official

Name: DR. ADRIANA FAUR
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 440-915-6515