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General NPI Number Information
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NPI Number | 1982470811
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS, LLC
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 3765 US-20
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City | ISLAND PARK
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State | ID
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Zip | 83429
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Country | US
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Telephone | 208-549-9970
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Fax |
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Provider Business Mailing Address
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Address Line | 2184 CHANNING WAY # 248
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8034
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA CHILD
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Credential | LMSW, PHD
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Telephone | 208-549-9970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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