Provider Demographics
NPI:1588428684
Name:INTEGRATIVE PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DNP, PMHNP
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:801-433-7418
Mailing Address - Street 1:1473 S COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-8183
Mailing Address - Country:US
Mailing Address - Phone:801-433-7418
Mailing Address - Fax:801-433-7778
Practice Address - Street 1:473 W 1400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7000
Practice Address - Country:US
Practice Address - Phone:801-433-7418
Practice Address - Fax:801-433-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty