Provider Demographics
NPI:1952063380
Name:INNOVATIVE HEALTH PRACTICE CENTER, LLC
Entity type:Organization
Organization Name:INNOVATIVE HEALTH PRACTICE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:659-239-0148
Mailing Address - Street 1:94 MCFARLAND BLVD, SUITE B
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-0108
Mailing Address - Country:US
Mailing Address - Phone:659-239-0148
Mailing Address - Fax:206-606-8311
Practice Address - Street 1:94 MCFARLAND BLVD, SUITE B
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3348
Practice Address - Country:US
Practice Address - Phone:659-239-0148
Practice Address - Fax:205-606-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty