MEDICARE: INTEGRATED PSYCHOTHERAPEUTIC SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1851699219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED PSYCHOTHERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 540594
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-0594
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 MAIN ST
Second Line	:	STE. 100
City	:	DALLAS
State	:	TX
Zip	:	75201-4360
Country	:	US
Telephone Number	:	214-331-1200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ENRIQUE O MORRIS
Credential	:
Telephone Number	:	214-331-1200

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	12/30/2014

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