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General NPI Number Information
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NPI Number | 1902610371
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Entity Type | Organization
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Legal Business Name | BE INTEGRATIVE PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 300 RED BUD MEMORIAL DRIVE
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City | PEKIN
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State | IL
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Zip | 61554
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Country | US
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Telephone | 309-863-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 300 RED BUD MEMORIAL DRIVE
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City | PEKIN
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State | IL
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Zip | 61554
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Country | US
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Telephone | 309-863-5255
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | REGINA BRIAN
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Credential |
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Telephone | 309-863-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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