Organization Name: | INTEGRATIVE WELL-BEING |
NPI Number: | 1033544150 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN L BERTILSON (OWNER) |
Mailing Address: | 1622 Shield St Laramie |
State: | WY US |
Postal Code: | 820722333 |
Phone Number: | 3077605450 |
Fax Number: | |
NPI Enumeration Date: | 09/09/2013 |
NPI Last Update Date: | 09/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCSW606 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |