Provider Demographics
NPI:1720756968
Name:INTEGRATED HEALTH COUNSELING, LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-200-3129
Mailing Address - Street 1:2616 S 1900 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4156
Mailing Address - Country:US
Mailing Address - Phone:801-200-3129
Mailing Address - Fax:801-928-7698
Practice Address - Street 1:4516 S 700 E STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-4192
Practice Address - Country:US
Practice Address - Phone:801-200-3129
Practice Address - Fax:801-928-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty