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General NPI Number Information
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NPI Number | 1497280366
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Entity Type | Organization
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Legal Business Name | WELLMIND
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 1411 MARSH ST SUITE 108
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2957
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Country | US
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Telephone | 805-459-8232
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Fax | 877-399-5883
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Provider Business Mailing Address
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Address Line | 1411 MARSH ST SUITE 108
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2957
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Country | US
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Telephone | 805-459-8232
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Fax | 877-399-5883
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL DAVID MCGEE
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Credential | M.D.
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Telephone | 805-459-8232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | G64445
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License Number State | CA
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