Healthcare Provider Details

I. General information

NPI: 1497216451
Provider Name (Legal Business Name): INTEGRATIVE MENTAL HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 SAINT ANDREWS RD STE 215
COLUMBIA SC
29210-4500
US

IV. Provider business mailing address

540 SAINT ANDREWS RD STE 215
COLUMBIA SC
29210-4581
US

V. Phone/Fax

Practice location:
  • Phone: 803-626-0712
  • Fax:
Mailing address:
  • Phone: 803-626-0712
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TERRI TALLEY
Title or Position: CLINICIAN
Credential: PC
Phone: 706-755-5324