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General NPI Number Information
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NPI Number | 1619113396
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PSYCHE SERVICES, S.C.
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE STE 212
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City | CHICAGO
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State | IL
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Zip | 60625-1037
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Country | US
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Telephone | 773-562-3276
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Fax |
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Provider Business Mailing Address
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Address Line | 2334 W LAWRENCE AVE STE 212
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City | CHICAGO
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State | IL
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Zip | 60625-1037
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Country | US
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Telephone | 773-562-3276
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Fax |
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Authorized Official
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Title or Position | CEO/PRACTICE OWNER
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Name | DAVID PAUL SMITH
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Credential |
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Telephone | 773-562-3276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006030
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License Number State | IL
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