Integrative Psychological Center Llc

LBN: Integrative Psychological Center Llc
Integrative Psychological Center Llc is an health care organization with primary practice located at 44 Capitol Ave Ste 402 , Hartford CT 06106-1764. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Forensic. Behavioral Health & Social Service Providers / Psychologist is the primary health care specialty. Integrative Psychological Center Llc can be contacted via phone (860) 466-9411, or through Wallace, Randall via phone (860) 466-9411.

Contact Information

Primary practice address
44 Capitol Ave Ste 402 Hartford CT 06106-1764
Phone: (860) 466-9411
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Wallace, Randall PSYD
Phone: (860) 466-9411

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X
Behavioral Health & Social Service Providers / Forensic 103TF0200X

Profile Details

NPI number 1306318670
LBN Legal business name Integrative Psychological Center Llc
DBA Doing business as
Authorized official Wallace, Randall PSYD
Entity Organization
Organization subpart 1 No
Enumeration date Dec 26th, 2018
Last updated Dec 26th, 2018 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306318670 NPPES
Connecticut MEDICAID 008042490

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