Provider Demographics
NPI:1265735864
Name:INTEGRATIVE MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:INTEGRATIVE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:307-631-2922
Mailing Address - Street 1:1282 HAFFNER CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4400
Mailing Address - Country:US
Mailing Address - Phone:307-631-2922
Mailing Address - Fax:307-316-0307
Practice Address - Street 1:1282 HAFFNER CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4400
Practice Address - Country:US
Practice Address - Phone:307-631-2922
Practice Address - Fax:307-316-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990045251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health