Provider Demographics
NPI:1649043845
Name:INTEGRATIVE WELLNESS, LLC
Entity type:Organization
Organization Name:INTEGRATIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COMANECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:601-627-0257
Mailing Address - Street 1:1821 HIGHWAY 39 N STE K
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-2725
Mailing Address - Country:US
Mailing Address - Phone:601-627-0257
Mailing Address - Fax:601-258-4682
Practice Address - Street 1:1821 HIGHWAY 39 N STE K
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-2725
Practice Address - Country:US
Practice Address - Phone:601-627-0257
Practice Address - Fax:601-258-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty