Healthcare Provider Details

I. General information

NPI: 1487391009
Provider Name (Legal Business Name): INTEGRA MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 LITTLE PATUXENT PKWY STE 260
COLUMBIA MD
21044-3581
US

IV. Provider business mailing address

10400 LITTLE PATUXENT PKWY STE 260
COLUMBIA MD
21044-3581
US

V. Phone/Fax

Practice location:
  • Phone: 240-763-7737
  • Fax: 877-763-6239
Mailing address:
  • Phone: 240-763-7737
  • Fax: 877-763-6239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESS ROMEO
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 205-602-7994