Provider Demographics
NPI:1902162050
Name:GAINESVILLE INTEGRATIVE PSYCHOTHERAPY P.A.
Entity Type:Organization
Organization Name:GAINESVILLE INTEGRATIVE PSYCHOTHERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:EDS LMFT
Authorized Official - Phone:352-262-4331
Mailing Address - Street 1:122 SW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1433
Mailing Address - Country:US
Mailing Address - Phone:352-262-4331
Mailing Address - Fax:855-800-9120
Practice Address - Street 1:4723 NW 53RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4803
Practice Address - Country:US
Practice Address - Phone:352-262-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty