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General NPI Number Information
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NPI Number | 1265735864
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 01/13/2013
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Provider Practice Location Address
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Address Line | 1282 HAFFNER CT
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City | LOVELAND
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State | CO
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Zip | 80537-4400
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Country | US
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Telephone | 307-631-2922
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Fax | 307-316-0307
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Provider Business Mailing Address
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Address Line | 1282 HAFFNER CT
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City | LOVELAND
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State | CO
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Zip | 80537-4400
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Country | US
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Telephone | 307-631-2922
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Fax | 307-316-0307
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. LORNA GAIL DAWSON
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Credential | PMHNP
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Telephone | 307-631-2922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 990045
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License Number State | CO
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