Provider Demographics
NPI:1548060908
Name:INTEGRAL LIFE PSYCHOLOGY AND EDUCATION
Entity type:Organization
Organization Name:INTEGRAL LIFE PSYCHOLOGY AND EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:510-541-8680
Mailing Address - Street 1:2243 CHERRYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1219
Mailing Address - Country:US
Mailing Address - Phone:510-541-8680
Mailing Address - Fax:
Practice Address - Street 1:20688 4TH ST # 4
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5894
Practice Address - Country:US
Practice Address - Phone:510-541-8680
Practice Address - Fax:833-806-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty