Organization
INTEGRATIVE LIFE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN REYNOLDS (EXECUTIVE DIRECTOR)
(615) 739-2276
Entity
Organization
Contact information
Practice address
1104 16TH AVE S, NASHVILLE, TN 37212-2305
(615) 891-2226
(615) 915-3813
Mailing address
1104 16TH AVE S, NASHVILLE, TN 37212-2305
(615) 891-2226
(615) 915-3813
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
1000000006277
TN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
1000000006277
TN
Other
Enumeration date
09/03/2010
Last updated
09/17/2024
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