=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528879707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS PSYCHOLOGY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2025
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 106 KM 2.2 INT.
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-515-4521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 118
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-0118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-371-8987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSICOLOGA
-----------------------------------------------------
Name | MICHELLE AVILES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-371-8987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------