Provider Demographics
NPI:1285982660
Name:INTEGRATED TREATMENT SERVICES, LLC
Entity type:Organization
Organization Name:INTEGRATED TREATMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDRIC
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:SPEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-612-4889
Mailing Address - Street 1:14362 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:SUITE B111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-8846
Mailing Address - Country:US
Mailing Address - Phone:480-788-8367
Mailing Address - Fax:480-383-6996
Practice Address - Street 1:14362 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:SUITE B111
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8846
Practice Address - Country:US
Practice Address - Phone:480-788-8367
Practice Address - Fax:480-383-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005284207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty