Healthcare Provider Details

I. General information

NPI: 1982292199
Provider Name (Legal Business Name): MOBILE WELLNESS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CUMBERLAND CROSSING DR. #108
VALPARAISO IN
46383
US

IV. Provider business mailing address

980 N MICHIGAN AVE STE 1090 PMB 344989
CHICAGO IL
60611-4521
US

V. Phone/Fax

Practice location:
  • Phone: 866-413-1988
  • Fax: 866-628-8599
Mailing address:
  • Phone: 866-413-1988
  • Fax: 866-628-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY TRAVIS
Title or Position: CEO
Credential: LCSW
Phone: 866-413-1988