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General NPI Number Information
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NPI Number | 1902129638
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH AND BEHAVIOR, PLLC
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 2310 N MOLTER RD STE 105
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-8621
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Country | US
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Telephone | 509-891-7867
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Fax | 509-922-0984
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Provider Business Mailing Address
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Address Line | 2310 N MOLTER RD STE 105
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-8621
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Country | US
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Telephone | 509-891-7867
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Fax | 509-922-0984
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Authorized Official
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Title or Position | TREASURER/OFFICE MANAGER
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Name | TAMARA FISHER WIRTHLIN
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Credential | JD
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Telephone | 509-891-7867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD00047831
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License Number State | WA
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