Active NPI
Integration Mental Health LLC
- Adult Psychiatric/Mental Health Clinical Nurse Specialist
- Greeley, CO
National Provider Identifier
1134592256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Psychiatric/Mental Health Clinical Nurse Specialist
- License
- 130627
- Legal business name
- INTEGRATION MENTAL HEALTH LLC
- Practice address
- 1919 65TH Ave Ste C
Greeley, CO 80634-7965 - Phone
- (970) 590-1138
- NPI assigned
- Nov 11, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Ponder
- Title
- Owner
- Phone
- (970) 590-1138
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0809X | 130627 | CO | Primary |
Addresses
Primary practice location
1919 65TH Ave Ste C
Greeley, CO 80634-7965
Mailing address
1919 65TH Ave Ste C
Greeley, CO 80634-7965
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336496330 | Other | CO | NPI-INDIVIDUAL |
| 15283739 | Medicaid | CO |
National Provider Directory
National Provider DirectoryLocations
1919 65th Ave
Ste C
Greeley, CO 80634
Phone (970) 590-1138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447200000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1690934400000",
"number": "1134592256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1919 65TH AVE STE C",
"city": "GREELEY",
"state": "CO",
"postal_code": "806347965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 65TH AVE STE C",
"city": "GREELEY",
"state": "CO",
"postal_code": "806347965",
"telephone_number": "970-590-1138"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INTEGRATION MENTAL HEALTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-11-11",
"last_updated": "2023-08-02",
"certification_date": "2023-08-02",
"status": "A",
"authorized_official_last_name": "PONDER",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "970-590-1138"
},
"taxonomies": [
{
"code": "364SP0809X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
"state": "CO",
"license": "130627",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI-INDIVIDUAL",
"identifier": "1336496330",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "15283739",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}
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- Liam Ireland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.