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General NPI Number Information
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NPI Number | 1881468734
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Entity Type | Organization
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Legal Business Name | INTEGRITY MODERN WELLNESS LLC
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Dates
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Enumeration Date | 11/10/2023
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 20 N 2ND ST STE 103
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City | NILES
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State | MI
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Zip | 49120-2259
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Country | US
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Telephone | 574-387-6576
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Fax | 269-397-2124
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Provider Business Mailing Address
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Address Line | 20 N 2ND ST STE 103
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City | NILES
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State | MI
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Zip | 49120-2259
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Country | US
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Telephone | 574-387-6576
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Fax | 269-397-2124
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Authorized Official
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Title or Position | OWNER
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Name | ROBIN HARVELL
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Credential | MA, LPC
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Telephone | 574-387-6576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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