Provider Demographics
NPI:1700122645
Name:CENTER FOR INTEGRATIVE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:CENTER FOR INTEGRATIVE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:603-223-0908
Mailing Address - Street 1:15 PLEASANT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4026
Mailing Address - Country:US
Mailing Address - Phone:603-223-0908
Mailing Address - Fax:603-223-0909
Practice Address - Street 1:15 PLEASANT ST
Practice Address - Street 2:SUITES 1-4
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4026
Practice Address - Country:US
Practice Address - Phone:603-223-0908
Practice Address - Fax:603-223-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH834101YM0800X
NH1198103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty