1316663420 NPI number — WELLNESS AND MENTAL HEALTH SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316663420 NPI number — WELLNESS AND MENTAL HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESS AND MENTAL HEALTH SERVICES, LLC
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:
1316663420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4291 S TAMIAMI TRL UNIT 1046
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34293-5131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-214-6070
Provider Business Mailing Address Fax Number:
941-219-5468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19815 BRIDGETOWN LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34293-2277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-214-6070
Provider Business Practice Location Address Fax Number:
941-219-5468
Provider Enumeration Date:
10/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BIGELOW
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-915-6298

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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