Provider Demographics
NPI:1033598982
Name:ALTITUDE IOP, LLC
Entity type:Organization
Organization Name:ALTITUDE IOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUKUP
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:540-953-5090
Mailing Address - Street 1:708 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5210
Mailing Address - Country:US
Mailing Address - Phone:540-953-5090
Mailing Address - Fax:540-953-5095
Practice Address - Street 1:708 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5210
Practice Address - Country:US
Practice Address - Phone:540-953-5090
Practice Address - Fax:540-953-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA953736133V00000X
VA0717001173106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty