Provider Demographics
NPI:1366259376
Name:INTEGRATING MOVEMENT AND CHANGE LLC
Entity type:Organization
Organization Name:INTEGRATING MOVEMENT AND CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:216-288-3501
Mailing Address - Street 1:24500 CENTER RIDGE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5602
Mailing Address - Country:US
Mailing Address - Phone:216-288-3501
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD STE 130
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5602
Practice Address - Country:US
Practice Address - Phone:216-288-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)