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Organization
INTEGRATIVE THERAPEUTIC SERVICES
Active
Organization
INTEGRATIVE THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA LEE GAUTHIER LCSW, LCDC (OWNER)
(310) 497-6176
Entity
Organization
Contact information
Practice address
1209 PARKWAY, AUSTIN, TX 78703-4132
(310) 497-6176
Mailing address
6211 SUNKIST LN, AUSTIN, TX 78749-1649
(310) 497-6176
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11589
TX
101YM0800X
Mental Health Counselor
55232
TX
1041C0700X
Clinical Social Worker
Primary
55232
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851761613
TYPE I NPI
TX
Enumeration date
04/22/2018
Last updated
06/11/2019
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