=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992614945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATIVE MENTAL HEALTH, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2026
-----------------------------------------------------
Last Update Date | 09/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2601 N CAMPBELL AVE STE 201
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85719-3167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-368-0984
-----------------------------------------------------
Fax | 520-372-0051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 85024
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85754-5024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-368-0984
-----------------------------------------------------
Fax | 520-372-0051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MELISSA FOGEL
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 520-368-0984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------