Provider Demographics
NPI:1588413538
Name:INTEGRATIVE MARRIAGE FAMILY AND INDIVIDUAL THERAPY, INCORPORATED
Entity type:Organization
Organization Name:INTEGRATIVE MARRIAGE FAMILY AND INDIVIDUAL THERAPY, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LA TISHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SAN PEDRO-LINTAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-583-4426
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:POLLOCK PINES
Mailing Address - State:CA
Mailing Address - Zip Code:95726-0445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 PLAZA DR STE 140
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4793
Practice Address - Country:US
Practice Address - Phone:530-206-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty