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General NPI Number Information
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NPI Number | 1437791068
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Entity Type | Organization
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Legal Business Name | PERINATAL WELLNESS INSTITUTE, LLC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 1480 WOODSTONE DR STE 112
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City | SAINT CHARLES
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State | MO
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Zip | 63304-6872
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Country | US
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Telephone | 636-699-2839
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Fax | 844-641-1015
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Provider Business Mailing Address
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Address Line | 1480 WOODSTONE DR STE 112
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City | SAINT CHARLES
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State | MO
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Zip | 63304-6872
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Country | US
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Telephone | 636-699-2839
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Fax | 844-641-1015
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAMIE K BODILY
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Credential | LPC
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Telephone | 636-699-2839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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