Integrative Mind Body Therapy, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

INTEGRATIVE MIND BODY THERAPY, LLC

Practice address

2511 Stadium Dr
Charleston, SC 29406-6606

Phone

(816) 752-6631

Fax

(844) 919-1630

NPI assigned

May 23, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lisa Fracica, LCPCNPI 1245852946

Title

Owner and Sole Member

Phone

(816) 752-6631

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Fracica, MA, LCPC, LGPAT

  • Professional Counselor
  • Charleston, SC
  • NPI 1245852946
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1407594153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 STADIUM DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294066606",
            "telephone_number": "816-752-6631",
            "fax_number": "844-919-1630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 STADIUM DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294066606",
            "telephone_number": "816-752-6631",
            "fax_number": "844-919-1630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MIND BODY THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-23",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "FRACICA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER AND SOLE MEMBER",
        "authorized_official_telephone_number": "816-752-6631",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Charleston, SC
• Providers in Charleston, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.