Provider Demographics
NPI:1164180469
Name:INTEGRATED WELLNESS THERAPIES LLC
Entity Type:Organization
Organization Name:INTEGRATED WELLNESS THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUFFIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-912-0258
Mailing Address - Street 1:1080 S VAN DYKE RD STE A
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9635
Mailing Address - Country:US
Mailing Address - Phone:989-912-0258
Mailing Address - Fax:
Practice Address - Street 1:1080 S VAN DYKE RD STE A
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9635
Practice Address - Country:US
Practice Address - Phone:989-912-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty