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General NPI Number Information
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NPI Number | 1982077426
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Entity Type | Organization
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Legal Business Name | INTEGRATED THERAPY
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 2908 CLEAR SPRINGS DR
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City | PLANO
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State | TX
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Zip | 75075-7602
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Country | US
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Telephone | 972-249-7331
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Fax |
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Provider Business Mailing Address
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Address Line | 2908 CLEAR SPRINGS DR
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City | PLANO
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State | TX
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Zip | 75075-7602
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Country | US
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Telephone | 972-249-7331
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Fax |
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Authorized Official
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Title or Position | NATURAL HEALING SOLUTIONS PROVIDER
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Name | DR. DAVID RYDER
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Credential | MMT, LMT, NCETMB
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Telephone | 972-249-7331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2357
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MT101016
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License Number State | TX
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