Healthcare Provider Details

I. General information

NPI: 1053879775
Provider Name (Legal Business Name): INTEGRATED WELLNESS AND MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W NEWMAN AVE
HARRISON AR
72601-5839
US

IV. Provider business mailing address

401 N 8TH ST UNIT 58
ROGERS AR
72757-7148
US

V. Phone/Fax

Practice location:
  • Phone: 479-318-2828
  • Fax:
Mailing address:
  • Phone: 479-469-0313
  • Fax: 497-769-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ZACHARIAH HODGSON
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 479-469-0313