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General NPI Number Information
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NPI Number | 1629861091
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Entity Type | Organization
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Legal Business Name | MENTAL WELLNESS PSYCHIATRY
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 188 HUCKLEBERRY LN
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City | FLORENCE
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State | OR
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Zip | 97439-8779
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Country | US
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Telephone | 541-725-2565
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Fax | 862-205-4480
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Provider Business Mailing Address
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Address Line | 2386 MORRIS AVE STE 205
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City | UNION
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State | NJ
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Zip | 07083-5723
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Country | US
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Telephone | 908-777-1617
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOLA FADIPE
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Credential | DNP
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Telephone | 541-725-2565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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