1831856467 NPI number — ELITE MENTAL HEALTH & WELLNESS, LLC

Table of content: (NPI 1831856467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831856467 NPI number — ELITE MENTAL HEALTH & WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE MENTAL HEALTH & WELLNESS, 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:
6
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:
1831856467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 BRIARWOOD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65020-6600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-410-9777
Provider Business Mailing Address Fax Number:
573-693-1003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5780 OSAGE BEACH PKWY STE 205A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE BEACH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65065-3188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-410-9777
Provider Business Practice Location Address Fax Number:
573-693-1003
Provider Enumeration Date:
11/18/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HOOKER
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
573-410-9777

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com