MEDICARE: INTEGRITY LIVING OPTIONS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1225646177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY LIVING OPTIONS, INC.

Provider Business Mailing Address
First Line	:	1121 JACKSON ST NE STE 113
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1637
Country	:	US
Telephone Number	:	612-236-1727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 JACKSON ST NE STE 113
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1637
Country	:	US
Telephone Number	:	612-236-1727
Fax Number	:

Authorized Official
Title or Position	:	DIR FINANCIAL OPERATIONS
Name	:	CARYN CONWAY
Credential	:
Telephone Number	:	612-236-1727

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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