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General NPI Number Information
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NPI Number | 1649043845
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE WELLNESS, LLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 1821 HIGHWAY 39 N STE K
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City | MERIDIAN
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State | MS
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Zip | 39301-2725
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Country | US
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Telephone | 601-627-0257
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Fax | 601-258-4682
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Provider Business Mailing Address
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Address Line | 1821 HIGHWAY 39 N STE K
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City | MERIDIAN
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State | MS
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Zip | 39301-2725
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Country | US
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Telephone | 601-627-0257
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Fax | 601-258-4682
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Authorized Official
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Title or Position | OWNER
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Name | COMANECHI CLAYTON
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Credential | PMHNP-BC
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Telephone | 601-627-0257
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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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