MEDICARE: WATERSHED WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1285597872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERSHED WELLNESS LLC

Provider Business Mailing Address
First Line	:	248 S BROAD ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 S BROAD ST
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-1504
Country	:	US
Telephone Number	:	724-201-9088
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BENNETT MINCHEN
Credential	:	LPC
Telephone Number	:	724-201-9088

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “WATERSHED WELLNESS LLC ” Practice Location

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