Provider Demographics
NPI:1972317774
Name:INTEGRATIVE WELLNESS THERAPY PLLC
Entity type:Organization
Organization Name:INTEGRATIVE WELLNESS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRINN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALERYCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-767-8080
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-0605
Mailing Address - Country:US
Mailing Address - Phone:269-767-8080
Mailing Address - Fax:269-360-4855
Practice Address - Street 1:215 E GREEN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1534
Practice Address - Country:US
Practice Address - Phone:269-767-8080
Practice Address - Fax:269-360-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty