Provider Demographics
NPI:1154291276
Name:INTEGRATIVE BODY MIND HEALTH, LLC
Entity type:Organization
Organization Name:INTEGRATIVE BODY MIND HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRIVATE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-769-9609
Mailing Address - Street 1:111 N HIGGINS AVE STE 204.2B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4437
Mailing Address - Country:US
Mailing Address - Phone:917-769-9609
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGGINS AVE STE 204.2B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4437
Practice Address - Country:US
Practice Address - Phone:917-769-9609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty