Provider Demographics
NPI:1891531513
Name:CP INTEGRATIVE PSYCHIATRY, LLC
Entity type:Organization
Organization Name:CP INTEGRATIVE PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN, PMHCNS-BC
Authorized Official - Phone:219-508-2947
Mailing Address - Street 1:2963 BRISBANE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-0041
Mailing Address - Country:US
Mailing Address - Phone:219-508-2947
Mailing Address - Fax:
Practice Address - Street 1:350 INDIAN BOUNDARY RD STE B
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-1511
Practice Address - Country:US
Practice Address - Phone:219-508-2947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty