Provider Demographics
NPI:1801508809
Name:INTEGRATE THERAPY AND WELLNESS COLLECTIVE
Entity type:Organization
Organization Name:INTEGRATE THERAPY AND WELLNESS COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORIO
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:610-883-6005
Mailing Address - Street 1:3749 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:GORDONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17529-9681
Mailing Address - Country:US
Mailing Address - Phone:610-883-6005
Mailing Address - Fax:
Practice Address - Street 1:3749 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:GORDONVILLE
Practice Address - State:PA
Practice Address - Zip Code:17529-9681
Practice Address - Country:US
Practice Address - Phone:610-883-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty