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General NPI Number Information
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NPI Number | 1033275458
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PSYCHIATRY, P.C.
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3701 W 49TH ST SUITE 206
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City | SIOUX FALLS
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State | SD
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Zip | 57106-4241
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Country | US
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Telephone | 605-338-1040
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Fax | 605-338-1102
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Provider Business Mailing Address
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Address Line | 3701 W 49TH ST SUITE 206
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City | SIOUX FALLS
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State | SD
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Zip | 57106-4241
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Country | US
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Telephone | 605-338-1040
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Fax | 605-338-1102
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBORAH SUSAN CAVANAUGH
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Credential | M.D.
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Telephone | 605-338-1040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5199
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License Number State | SD
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