Provider Demographics
NPI:1457353930
Name:INTEGRATIVE HEALTH PSYCHOLOGY PA
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH PSYCHOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-706-0622
Mailing Address - Street 1:2441 W SR 426
Mailing Address - Street 2:SUITE 1021
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4515
Mailing Address - Country:US
Mailing Address - Phone:407-706-0622
Mailing Address - Fax:407-706-0623
Practice Address - Street 1:2441 W SR 426
Practice Address - Street 2:SUITE 1021
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4515
Practice Address - Country:US
Practice Address - Phone:407-706-0622
Practice Address - Fax:407-706-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-14
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94987OtherBCBS
FL94987OtherBCBS