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General NPI Number Information
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NPI Number | 1568161701
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Entity Type | Organization
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Legal Business Name | COMWELL
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 1101 OPDYKE ST
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City | CHESTER
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State | IL
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Zip | 62233-2004
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Country | US
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Telephone | 618-282-6233
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Fax | 888-388-1971
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Provider Business Mailing Address
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Address Line | 10257 STATE ROUTE 3
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City | RED BUD
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State | IL
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Zip | 62278-4418
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Country | US
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Telephone | 618-282-6233
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Fax |
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Authorized Official
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Title or Position | EHR SUPERVISOR
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Name | AMY BAUER
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Credential |
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Telephone | 618-282-6233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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