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General NPI Number Information
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NPI Number | 1962944520
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Entity Type | Organization
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Legal Business Name | INTEGRATED PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 3035 S MARYLAND PKWY SUITE 110
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City | LAS VEGAS
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State | NV
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Zip | 89109-2202
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Country | US
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Telephone | 702-751-2547
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 82403
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City | LAS VEGAS
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State | NV
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Zip | 89180-2403
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Country | US
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Telephone | 702-751-2547
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KRISTI A WALTER
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Credential | PSYD
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Telephone | 702-751-2547
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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 | PY0526
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License Number State | NV
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