Healthcare Provider Details

I. General information

NPI: 1295443141
Provider Name (Legal Business Name): INTEGRATED FAMILY WELLNESS, TRAINING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 KENDALL ST
ARVADA CO
80003-4628
US

IV. Provider business mailing address

6444 KENDALL ST
ARVADA CO
80003-4628
US

V. Phone/Fax

Practice location:
  • Phone: 224-572-8545
  • Fax:
Mailing address:
  • Phone: 224-572-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES LEE PAVLIK JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, CTTP
Phone: 224-572-8548