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General NPI Number Information
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NPI Number | 1952063380
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HEALTH PRACTICE CENTER, LLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 94 MCFARLAND BLVD, SUITE B
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City | NORTHPORT
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State | AL
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Zip | 35476-3348
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Country | US
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Telephone | 659-239-0148
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Fax | 205-606-8311
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Provider Business Mailing Address
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Address Line | 94 MCFARLAND BLVD, SUITE B
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City | NORTHPORT
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State | AL
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Zip | 35476-0108
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Country | US
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Telephone | 659-239-0148
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Fax | 206-606-8311
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Authorized Official
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Title or Position | OWNER
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Name | LATONIA MITCHELL
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Credential | PMHNP
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Telephone | 659-239-0148
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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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