Provider Demographics
NPI:1477010726
Name:INTEGRATIVE MENTAL HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MENTAL HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:PHARIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC
Authorized Official - Phone:803-272-9593
Mailing Address - Street 1:3101 PETIGRU ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3619
Mailing Address - Country:US
Mailing Address - Phone:803-272-9593
Mailing Address - Fax:
Practice Address - Street 1:540 SAINT ANDREWS RD STE 215
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4500
Practice Address - Country:US
Practice Address - Phone:803-272-9593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1424Medicaid