1699928093 NPI number — MENTAL WELLNESS

Table of content: (NPI 1699928093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699928093 NPI number — MENTAL WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699928093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 POPLAR VIEW LN S
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
COLLIERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38017-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-457-7871
Provider Business Mailing Address Fax Number:
901-451-7872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 POPLAR VIEW LN S
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
COLLIERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38017-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-457-7871
Provider Business Practice Location Address Fax Number:
901-457-7872
Provider Enumeration Date:
10/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNUERER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
901-457-7871

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  APN 7280 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518037662 . This is a "PERSONAL NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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