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General NPI Number Information
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NPI Number | 1083345458
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Entity Type | Organization
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Legal Business Name | MIGHTY WARRIOR WELLNESS, PC
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 125 S BROADWAY ST
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City | CASSOPOLIS
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State | MI
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Zip | 49031-1242
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Country | US
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Telephone | 269-414-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 125 S BROADWAY ST
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City | CASSOPOLIS
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State | MI
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Zip | 49031-1242
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Country | US
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Telephone | 269-414-8534
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLA LOWE
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Credential | LPC, CAADC
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Telephone | 269-414-8534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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