Healthcare Provider Details

I. General information

NPI: 1801066873
Provider Name (Legal Business Name): NUTEGRA MENTAL HEALTH AND NUTRITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NW PEACOCK BLVD STE 102
PORT ST LUCIE FL
34986-2349
US

IV. Provider business mailing address

1751 HUNTER CREEK DR
PUNTA GORDA FL
33982-1135
US

V. Phone/Fax

Practice location:
  • Phone: 941-787-3525
  • Fax: 941-257-5550
Mailing address:
  • Phone: 941-740-0193
  • Fax: 941-257-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberND 2695
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISANNA G WRIGHT
Title or Position: PRESIDENT
Credential: LMHC
Phone: 941-787-3525