Provider Demographics
NPI:1194115162
Name:INTEGRATED THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:INTEGRATED THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-365-4819
Mailing Address - Street 1:55379 29 PALMS HWY
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2501
Mailing Address - Country:US
Mailing Address - Phone:760-365-4819
Mailing Address - Fax:
Practice Address - Street 1:55379 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2501
Practice Address - Country:US
Practice Address - Phone:760-365-4819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAPSY12146251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty