Organization · NPI-2

Integralife Health & Trauma Institute, LLC

Community/Behavioral Health · Moreno Valley, CA

NPI number1760869770

StatusActive

Last updated in NPPESApr 28, 2015

Details

NPI: 1760869770
Entity type: Organization (NPI-2)
Legal business name: Integralife Health & Trauma Institute, LLC
Organization subpart: No
Enumeration date: Apr 28, 2015
Last updated: Apr 28, 2015

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
251S00000X	Community/Behavioral Health	–	–	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
101YM0800X	Counselor, Mental Health	–	–
101YP2500X	Counselor, Professional	–	–
1041C0700X	Social Worker, Clinical	–	–
106H00000X	Marriage & Family Therapist	–	–
252Y00000X	Early Intervention Provider Agency	–	–

Practice location

12730 Heacock St
Suite 7
Moreno Valley, CA 92553-3070

Phone 951-221-3460 · Fax 951-924-0250

Mailing address

12730 Heacock St
Suite 7
Moreno Valley, CA 92553-3070

Phone 951-221-3460 · Fax 951-924-0250

Authorized official

Blessing A. Okoro Rellias
President & Ceo
9512213460

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