Provider Demographics
NPI:1104246529
Name:INTEGRATIVE PSYCHOLOGICAL & CONSULTING SERVICES
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHOLOGICAL & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAMETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:267-252-3449
Mailing Address - Street 1:2708 SOCIETY DR
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-1763
Mailing Address - Country:US
Mailing Address - Phone:267-252-3449
Mailing Address - Fax:267-299-2578
Practice Address - Street 1:1 BALA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3212
Practice Address - Country:US
Practice Address - Phone:267-252-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health