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General NPI Number Information
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NPI Number | 1720785181
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Entity Type | Organization
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Legal Business Name | MENTALWELL LLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 30 N GOULD ST STE 20856
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 307-228-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST STE 20856
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 307-228-5310
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MOHAMED ELARBI
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Credential |
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Telephone | 786-694-7346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/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 | 363LA2200X
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Taxonomy Name | Adult Health 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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