Provider Demographics
NPI:1043966153
Name:THE INTEGRATIVE HEALING SPACE LLC
Entity Type:Organization
Organization Name:THE INTEGRATIVE HEALING SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:POYSER-NAVRATIL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-234-2924
Mailing Address - Street 1:9314 FOREST HILL BLVD # 30
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6577
Mailing Address - Country:US
Mailing Address - Phone:561-316-7664
Mailing Address - Fax:
Practice Address - Street 1:9314 FOREST HILL BLVD # 30
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33411-6577
Practice Address - Country:US
Practice Address - Phone:561-316-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty