Organization Active NPI

Integration Mental Health LLC

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Greeley, CO
National Provider Identifier
1134592256
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0809X
License
130627 Issued in CO
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

Updated by the provider on Aug 2, 2023

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)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 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

IdentifierTypeStateIssuer
1336496330OtherCONPI-INDIVIDUAL
15283739MedicaidCO

National Provider Directory

National Provider Directory

Locations

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": []
}

Other providers in Greeley, CO

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.

Verify at the official NPI Registry.