=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598549818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIVOT INTEGRATIVE HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2023
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 S CHURCH ST
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-336-6450
-----------------------------------------------------
Fax | 949-695-3327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 323 S CHURCH ST
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-336-6450
-----------------------------------------------------
Fax | 949-695-3327
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. LAUREN HANNAH
-----------------------------------------------------
Credential | DSW, LCSW
-----------------------------------------------------
Telephone | 870-273-3980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------