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General NPI Number Information
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NPI Number | 1184377285
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE AMD HOLISTIC CENTER, LLC
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 375 N MAIN ST STE 202
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City | KAYSVILLE
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State | UT
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Zip | 84037-1278
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Country | US
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Telephone | 801-923-3290
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Fax |
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Provider Business Mailing Address
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Address Line | 375 N MAIN ST STE 202
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City | KAYSVILLE
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State | UT
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Zip | 84037-1278
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Country | US
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Telephone | 801-923-3290
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | SOPHIE ARCHIBALD
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Credential | LCSW
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Telephone | 801-923-3290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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