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General NPI Number Information
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NPI Number | 1972317774
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE WELLNESS THERAPY PLLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 215 E GREEN ST
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City | MARSHALL
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State | MI
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Zip | 49068-1534
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Country | US
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Telephone | 269-767-8080
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Fax | 269-360-4855
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Provider Business Mailing Address
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Address Line | PO BOX 605
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City | MARSHALL
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State | MI
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Zip | 49068-0605
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Country | US
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Telephone | 269-767-8080
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Fax | 269-360-4855
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Authorized Official
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Title or Position | OWNER
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Name | BRINN WALERYCH
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Credential | LMSW
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Telephone | 269-767-8080
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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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