Organization
INTEGRATED TMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FORREST JIM WOLVERTON (OWNER/DIRECTOR)
(435) 767-8840
Entity
Organization
Contact information
Practice address
1664 S DIXIE DR STE 102, BLD E, SAINT GEORGE, UT 84770-7327
(435) 767-8840
(435) 703-6003
Mailing address
1664 S DIXIE DR STE 102, BLD E, SAINT GEORGE, UT 84770-7327
(435) 767-8840
(435) 703-6003
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730125956
—
UT
05
—
1972846384
—
UT
Enumeration date
06/23/2021
Last updated
06/28/2021
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