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General NPI Number Information
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NPI Number | 1548465883
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PSYCHOLOGICAL SERVICES, P.A.
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 10480 PERKINS AVE N
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City | STILLWATER
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State | MN
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Zip | 55082-9273
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Country | US
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Telephone | 651-357-3216
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Fax | 651-430-8085
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Provider Business Mailing Address
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Address Line | 10480 PERKINS AVE N
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City | STILLWATER
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State | MN
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Zip | 55082-9273
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Country | US
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Telephone | 651-357-3216
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Fax | 651-430-8085
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. MARY GENEVIEVE FREITAG
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Credential | PSY.D., L.P.
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Telephone | 651-357-3216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4319
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License Number State | MN
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