Healthcare Provider Details

I. General information

NPI: 1164860037
Provider Name (Legal Business Name): WELLNESS INX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E MICHIGAN AVE
LANSING MI
48912-2894
US

IV. Provider business mailing address

1601 E MICHIGAN AVE
LANSING MI
48912-2894
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-0520
  • Fax: 517-272-0483
Mailing address:
  • Phone: 517-272-0520
  • Fax: 517-272-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number330345
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSA0330345
License Number StateMI

VIII. Authorized Official

Name: DR. DEBORAH J SMITH
Title or Position: OWNER/PROGRAM DIRECTOR
Credential: PHD, MDIV
Phone: 517-272-0520