OrganizationIntegrating Body, Mind And Life, Llc(Ibml. Llc.)CounselorBehavioral Health & Social Service ProvidersPractice Address2365 Wall St SE, Suite 200-05, Conyers, GA 30013-2197(866) 298-3447PECOS EnrollmentBased on the most recent information from CMS, provider Integrating Body, Mind And Life, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1750559217Provider TypeOrganizationFull NameIntegrating Body, Mind And Life, LlcOther NameIbml. Llc.SubpartNoEnumeration Date2/18/2008Last Updated2/14/2014Contact InformationPractice LocationPractice Address2365 Wall St SE, Suite 200-05, Conyers, GA 30013-2197Phone(866) 298-3447Fax(866) 261-5260Mailing LocationMailing Address1 W Court Sq, Suite 750, Decatur, GA 30030-2538Phone(866) 298-3447Fax(866) 261-5260Authorized OfficialNameEtienne, Mireille (Partner/Therapist)Phone(866) 298-3447Provider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseLPC004290GeorgiaProvider IdentifiersIDDescriptionIssuerID11824149DescriptionOtherIssuerCAQHGeorgiaID476557646ADescriptionMedicaidIssuerUnlistedGeorgia