Healthcare Provider Details

I. General information

NPI: 1407535073
Provider Name (Legal Business Name): MAE MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 VISTA PKWY STE 400
WEST PALM BEACH FL
33411-6742
US

IV. Provider business mailing address

2054 VISTA PKWY STE 400
WEST PALM BEACH FL
33411-6742
US

V. Phone/Fax

Practice location:
  • Phone: 561-231-0233
  • Fax: 561-203-3447
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIN A LUTCHKUS
Title or Position: CEO
Credential: APRN, PMHNP-BC
Phone: 561-908-3076