Provider Demographics
NPI:1518798610
Name:INTEGRATIVE WELLNESS INSTITUTE OF TAMPA
Entity type:Organization
Organization Name:INTEGRATIVE WELLNESS INSTITUTE OF TAMPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD, MS-CMHC, MHA
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:VANGELENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-955-9522
Mailing Address - Street 1:114 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33786-3302
Mailing Address - Country:US
Mailing Address - Phone:928-955-9522
Mailing Address - Fax:
Practice Address - Street 1:14506 UNIVERSITY POINT PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5425
Practice Address - Country:US
Practice Address - Phone:813-971-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-10
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty