Provider Demographics
NPI:1942002340
Name:INTEGRATIVE MIND & BODY WELLNESS LLC
Entity type:Organization
Organization Name:INTEGRATIVE MIND & BODY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, BCN, BCB
Authorized Official - Phone:970-219-9089
Mailing Address - Street 1:801 S PERRY ST STE 115
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1986
Mailing Address - Country:US
Mailing Address - Phone:970-219-9089
Mailing Address - Fax:
Practice Address - Street 1:801 S PERRY ST STE 115
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1986
Practice Address - Country:US
Practice Address - Phone:970-219-9089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty