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General NPI Number Information
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NPI Number | 1376320440
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE BEHAVIORAL HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 258 SW 5TH ST STE 2
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City | REDMOND
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State | OR
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Zip | 97756-2150
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Country | US
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Telephone | 541-203-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 258 SW 5TH ST STE 2
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City | REDMOND
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State | OR
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Zip | 97756-2150
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Country | US
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Telephone | 541-203-0771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACKLYNN CRUMP
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Credential | PMHNP
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Telephone | 541-203-0771
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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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