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General NPI Number Information
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NPI Number | 1174281364
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL WELLNESS CENTER LLC
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Dates
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Enumeration Date | 12/04/2021
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 263 INDUSTRIAL DR
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City | HILLSDALE
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State | MI
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Zip | 49242-1078
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Country | US
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Telephone | 517-826-5242
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Fax | 517-826-5246
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Provider Business Mailing Address
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Address Line | PO BOX 174
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City | JONESVILLE
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State | MI
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Zip | 49250-0174
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | SAMANTHA A COREY
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Credential | MA
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Telephone | 517-826-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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