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General NPI Number Information
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NPI Number | 1336718204
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Entity Type | Organization
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Legal Business Name | INTEGRATED TMS LLC
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 1664 S DIXIE DR STE 102 BLD E
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City | SAINT GEORGE
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State | UT
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Zip | 84770-7327
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Country | US
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Telephone | 435-767-8840
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Fax | 435-703-6003
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Provider Business Mailing Address
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Address Line | 1664 S DIXIE DR STE 102 BLD E
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City | SAINT GEORGE
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State | UT
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Zip | 84770-7327
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Country | US
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Telephone | 435-767-8840
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Fax | 435-703-6003
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | FORREST JIM WOLVERTON
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Credential |
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Telephone | 435-767-8840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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