Organization
INTEGRATIVE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNETTE CLARK (MANAGING MEMBER)
(765) 366-4621
Entity
Organization
Contact information
Practice address
1310 S LEBANON ST STE C, LEBANON, IN 46052-3077
(765) 680-0071
(765) 680-0468
Mailing address
1310 S LEBANON ST STE C, LEBANON, IN 46052-3077
(765) 680-0071
(765) 680-0468
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20119298A
—
IN
Enumeration date
07/23/2013
Last updated
01/23/2025
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