Healthcare Provider Details

I. General information

NPI: 1326901315
Provider Name (Legal Business Name): INTEGRATIVE MENTAL HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 OLD YORK RD
ABINGTON PA
19001-4607
US

IV. Provider business mailing address

941 OLD YORK RD
ABINGTON PA
19001-4607
US

V. Phone/Fax

Practice location:
  • Phone: 267-209-0449
  • Fax: 844-991-3571
Mailing address:
  • Phone: 267-209-0449
  • Fax: 844-991-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: TOMMY MARKOV
Title or Position: DIRECTOR OF NUTRITION
Credential: LDN
Phone: 267-209-0449