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NPI Code Detail

MEDICARE: INTEGRATED PSYCHOLOGICAL LLC

MEDICARE: INTEGRATED PSYCHOLOGICAL LLC
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
1103T00000XPsychologistPY0610NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346641206
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED PSYCHOLOGICAL LLC
Provider Business Mailing Address
First Line : 9183 W FLAMINGO RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6464
Country : US
Telephone Number : 702-335-9394
Fax Number :
Provider Business Practice Location Address
First Line : 9183 W FLAMINGO RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6464
Country : US
Telephone Number : 702-335-9394
Fax Number :
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST
Name : DR. AYAKO SAKURAGI
Credential : PSYD
Telephone Number : 702-335-9394
Provider Enumeration Date : 09/10/2014
Last Update Date : 04/14/2016

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Directions to “INTEGRATED PSYCHOLOGICAL LLC ” Practice Location

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