Healthcare Provider Details

I. General information

NPI: 1598549818
Provider Name (Legal Business Name): PIVOT INTEGRATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S CHURCH ST
JONESBORO AR
72401-2913
US

IV. Provider business mailing address

323 S CHURCH ST
JONESBORO AR
72401-2913
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-6450
  • Fax: 949-695-3327
Mailing address:
  • Phone: 870-336-6450
  • Fax: 949-695-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN HANNAH
Title or Position: CO-OWNER
Credential: DSW, LCSW
Phone: 870-273-3980