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NPI Code Detail

MEDICARE: INTEGRATIVE DIMENSIONAL HEALING, LLC

MEDICARE: INTEGRATIVE DIMENSIONAL HEALING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1174152334
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATIVE DIMENSIONAL HEALING, LLC
Provider Business Mailing Address
First Line : 866 WANDERING WOODS WAY
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-0628
Country : US
Telephone Number : 708-800-7700
Fax Number :
Provider Business Practice Location Address
First Line : 10752 DEERWOOD PARK BLVD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4846
Country : US
Telephone Number : 904-806-4837
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LISA LEMKE
Credential : LMFT
Telephone Number : 708-800-7700
Provider Enumeration Date : 04/08/2020
Last Update Date : 04/08/2020

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Directions to “INTEGRATIVE DIMENSIONAL HEALING, LLC ” Practice Location

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