MEDICARE: INTEGRATED WELLNESS COUNSELING CENTER

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
1	363L00000X	Nurse Practitioner
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1649046970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED WELLNESS COUNSELING CENTER

Provider Business Mailing Address
First Line	:	1101 5TH ST STE 103
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2904
Country	:	US
Telephone Number	:	319-531-7799
Fax Number	:	319-344-4486

Provider Business Practice Location Address
First Line	:	1101 5TH ST STE 103
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2904
Country	:	US
Telephone Number	:	319-531-7799
Fax Number	:	319-344-4486

Authorized Official
Title or Position	:	CO-OWNER
Name	:	BRIDGET CASEY BRENTON
Credential	:	LISW
Telephone Number	:	319-531-7799

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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Directions to “INTEGRATED WELLNESS COUNSELING CENTER ” Practice Location

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