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General NPI Number Information
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NPI Number | 1861152530
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MENTAL HEALTH THERAPIES
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 330 MILLTOWN RD STE 22
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-2267
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Country | US
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Telephone | 908-992-9227
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Fax |
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Provider Business Mailing Address
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Address Line | 5406 WOODLAND AVE SUITE 2305
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City | POCONO PINES
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State | PA
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Zip | 18350
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Country | US
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Telephone | 732-841-9191
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | GRACE ELIZABETH PETERS
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Credential | APN
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Telephone | 732-841-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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