Healthcare Provider Details

I. General information

NPI: 1194392365
Provider Name (Legal Business Name): 540 HEALING & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 TAUNTON AVE STE B
SEEKONK MA
02771-6103
US

IV. Provider business mailing address

PO BOX 363
SEEKONK MA
02771-0363
US

V. Phone/Fax

Practice location:
  • Phone: 774-991-3559
  • Fax: 401-216-6231
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BROWN
Title or Position: OWNER
Credential: LMHC
Phone: 401-714-2891