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General NPI Number Information
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NPI Number | 1932615960
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE THERAPY SOLUTIONS BH LLC
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 915 NE 20TH AVE STE B
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3037
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Country | US
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Telephone | 954-648-5488
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 NE 3RD ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-1743
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARLA REIS
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Credential | PHD
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Telephone | 954-648-5488
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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 | PY8176
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License Number State | FL
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