Provider Demographics
NPI:1548679582
Name:INTEGRATED PRACTITIONERS CENTER INC
Entity type:Organization
Organization Name:INTEGRATED PRACTITIONERS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TETRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-648-0600
Mailing Address - Street 1:268 MILE LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-4724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 240 B
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7132
Practice Address - Country:US
Practice Address - Phone:814-648-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103T00000X, 1041C0700X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty