Provider Demographics
NPI:1588259956
Name:INSIGHT INTEGRATIVE MENTAL HEALTH
Entity type:Organization
Organization Name:INSIGHT INTEGRATIVE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:AYESHA
Authorized Official - Last Name:MACON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-615-8566
Mailing Address - Street 1:612 TOM SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4329
Mailing Address - Country:US
Mailing Address - Phone:410-615-8566
Mailing Address - Fax:
Practice Address - Street 1:612 TOM SAWYER RD
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4329
Practice Address - Country:US
Practice Address - Phone:410-615-8566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)