Integrative Wellness, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

INTEGRATIVE WELLNESS, LLC

Practice address

1310 S Lebanon St Ste C
Lebanon, IN 46052-3077

Phone

(765) 680-0071

Fax

(765) 680-0468

NPI assigned

Jul 23, 2013

Last updated

Jan 23, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lynette Clark

Title

Managing Member

Phone

(765) 366-4621

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Elliott, LCSW

  • Clinical Social Worker
  • Bloomington, IN
  • NPI 1407109671
  Medicare reassignment Care Compare group NPD
• Kaitlin Faust, LCSW

  • Clinical Social Worker
  • Zionsville, IN
  • NPI 1235914755
  Medicare reassignment Care Compare group NPD
• Leah J Freeland, LMHC

  • Mental Health Counselor
  • Lebanon, IN
  • NPI 1407824055
  Medicare reassignment Care Compare group NPD
• Crystal L Jones, MD

  • Infectious Disease Physician
  • Lebanon, IN
  • NPI 1356307003
  Medicare reassignment Care Compare group NPD
• Kiersten E. Olsen, MD

  • Psychiatry Physician
  • Madison, WI
  • NPI 1720617228

  IN

  Medicare reassignment Care Compare group NPD
• Christopher G Christmas, PHD, LMHC

  • Mental Health Counselor
  • Dayton, IN
  • NPI 1932415973

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD
• Lindsay Marie Diemer, DO

  • Child & Adolescent Psychiatry Physician
  • Lebanon, IN
  • NPI 1023457124
  Medicare reassignment NPD
• Donna Renee Gill, MD

  • Psychiatry Physician
  • Zionsville, IN
  • NPI 1316101363
  Medicare reassignment NPD
• Gabrielle E. Goldstein, LCSW

  • Clinical Social Worker
  • Lebanon, IN
  • NPI 1871181321
  Medicare reassignment NPD
• Jessica Erin Haltom, NP

  • Family Nurse Practitioner
  • Clarksville, IN
  • NPI 1548004500
  Medicare reassignment NPD
• Heather Ellen Metzger, APRN

  • Family Nurse Practitioner
  • Seymour, IN
  • NPI 1750866430
  Medicare reassignment NPD
• Elaine Ilene Myers, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lafayette, IN
  • NPI 1841054632

  Multi-Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1750723490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 S LEBANON ST STE C",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460523077",
            "telephone_number": "765-680-0071",
            "fax_number": "765-680-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 S LEBANON ST STE C",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460523077",
            "telephone_number": "765-680-0071",
            "fax_number": "765-680-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LYNETTE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "765-366-4621"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20119298A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mark J Janicki, MD, FAAN
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• Angela Joy Johnson, LCSW

• Psychiatry Physician in Lebanon, IN
• Providers in Lebanon, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.