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General NPI Number Information
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NPI Number | 1205585114
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MENTAL HEALTH GROUP, PLLC
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Dates
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Enumeration Date | 03/20/2022
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Last Update Date | 03/20/2022
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Provider Practice Location Address
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Address Line | 1931 NW 150TH AVE STE 272
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2885
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Country | US
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Telephone | 954-588-8821
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Fax |
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Provider Business Mailing Address
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Address Line | 1931 NW 150TH AVE STE 272
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2885
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Country | US
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Telephone | 954-588-8821
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | EMMANUETTE JOHNSON
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Credential | LCSW
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Telephone | 954-588-8821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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