MEDICARE: INTEGRATIVE BODY MIND HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1154291276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE BODY MIND HEALTH, LLC

Provider Business Mailing Address
First Line	:	111 N HIGGINS AVE STE 204.2B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4437
Country	:	US
Telephone Number	:	917-769-9609
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N HIGGINS AVE STE 204.2B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4437
Country	:	US
Telephone Number	:	917-769-9609
Fax Number	:

Authorized Official
Title or Position	:	OWNER OF PRIVATE PRACTICE
Name	:	JENNIFER ANN CARLSON
Credential	:	LCSW
Telephone Number	:	917-769-9609

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	11/05/2025

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