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General NPI Number Information
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NPI Number | 1164860037
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Entity Type | Organization
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Legal Business Name | WELLNESS INX
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 1601 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912-2894
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Country | US
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Telephone | 517-272-0520
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Fax | 517-272-0483
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Provider Business Mailing Address
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Address Line | 1601 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912-2894
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Country | US
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Telephone | 517-272-0520
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Fax | 517-272-0483
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | DR. DEBORAH J SMITH
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Credential | PHD, MDIV
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Telephone | 517-272-0520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 330345
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License Number State | MI
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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 | SA0330345
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License Number State | MI
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