Provider Demographics
NPI:1902129638
Name:INTEGRATED HEALTH AND BEHAVIOR, PLLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH AND BEHAVIOR, PLLC
Other - Org Name:IHB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:FISHER
Authorized Official - Last Name:WIRTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:509-891-7867
Mailing Address - Street 1:2310 N MOLTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8621
Mailing Address - Country:US
Mailing Address - Phone:509-891-7867
Mailing Address - Fax:509-922-0984
Practice Address - Street 1:2310 N MOLTER RD STE 105
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8621
Practice Address - Country:US
Practice Address - Phone:509-891-7867
Practice Address - Fax:509-922-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000478312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487664603OtherNPI FOR INDIVIDUAL