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General NPI Number Information
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NPI Number | 1366481749
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Entity Type | Organization
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Legal Business Name | INTEGRAL PSYCHOLOGY CENTER
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1619 MONROE ST
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City | MADISON
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State | WI
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Zip | 53711-2063
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Country | US
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Telephone | 608-255-9330
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Fax | 608-255-7810
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Provider Business Mailing Address
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Address Line | 1619 MONROE ST
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City | MADISON
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State | WI
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Zip | 53711-2063
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Country | US
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Telephone | 608-255-9330
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Fax | 608-255-7810
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS MERRITT
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Credential | L.C.S.W, PH.D
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Telephone | 608-255-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1914
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License Number State | WI
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