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General NPI Number Information
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NPI Number | 1376232934
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Entity Type | Organization
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Legal Business Name | INTEGRATE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 120 ALISO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2693
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Country | US
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Telephone | 505-600-2314
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Fax | 866-635-1177
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Provider Business Mailing Address
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Address Line | PO BOX 36072
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City | ALBUQUERQUE
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State | NM
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Zip | 87176-6072
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Country | US
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Telephone | 505-600-2314
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | ELIZABETH DIESEL
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Credential | LCSW
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Telephone | 505-600-2314
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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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