Provider Demographics
NPI:1972155539
Name:INTEGRATIVE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH AND WELLNESS LLC
Other - Org Name:INTEGRATIVE MENTAL HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN OS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-C
Authorized Official - Phone:801-691-7064
Mailing Address - Street 1:2666 S 2000 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1721
Mailing Address - Country:US
Mailing Address - Phone:801-691-7064
Mailing Address - Fax:801-855-7998
Practice Address - Street 1:2666 S 2000 E STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1721
Practice Address - Country:US
Practice Address - Phone:801-631-9363
Practice Address - Fax:801-855-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-14
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty