Healthcare Provider Details

I. General information

NPI: 1992252670
Provider Name (Legal Business Name): INTEGRATIVE HEALTH AND BEHAVIORAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 ESTATE THOMAS STE 104
ST THOMAS VI
00802-2612
US

IV. Provider business mailing address

9150 ESTATE THOMAS STE 104
ST THOMAS VI
00802-2612
US

V. Phone/Fax

Practice location:
  • Phone: 340-244-9658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1957
License Number StateVI

VIII. Authorized Official

Name: DR. LAURIE MCPEARCE
Title or Position: MD
Credential:
Phone: 340-244-9658