Provider Demographics
NPI:1982470811
Name:INTEGRATED WELLNESS, LLC
Entity Type:Organization
Organization Name:INTEGRATED WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, PHD
Authorized Official - Phone:208-549-9970
Mailing Address - Street 1:2184 CHANNING WAY # 248
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3765 US-20
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:ID
Practice Address - Zip Code:83429
Practice Address - Country:US
Practice Address - Phone:208-549-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty