Provider Demographics
NPI:1285791954
Name:INTEGRATED THERAPIES, A FAMILY COUNSELING CORPORATION
Entity type:Organization
Organization Name:INTEGRATED THERAPIES, A FAMILY COUNSELING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:760-946-2804
Mailing Address - Street 1:20258 HWY 18
Mailing Address - Street 2:SUITE 430-449
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-946-2804
Mailing Address - Fax:760-946-0378
Practice Address - Street 1:20601 US HIGHWAY 18 STE 158
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-3567
Practice Address - Country:US
Practice Address - Phone:760-946-2804
Practice Address - Fax:760-946-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMCF31725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty