Provider Demographics
NPI:1124549084
Name:INTEGRATED WELLNESS SOLUTIONS INC
Entity Type:Organization
Organization Name:INTEGRATED WELLNESS SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LIBRIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-492-5309
Mailing Address - Street 1:808 MATHEWS ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3315
Mailing Address - Country:US
Mailing Address - Phone:970-492-5309
Mailing Address - Fax:
Practice Address - Street 1:808 MATHEWS ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3315
Practice Address - Country:US
Practice Address - Phone:970-492-5309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1519261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88589528Medicaid