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General NPI Number Information
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NPI Number | 1801147863
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Entity Type | Organization
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Legal Business Name | WELLNESS COMPANY II
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Dates
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Enumeration Date | 09/30/2012
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Last Update Date | 09/30/2012
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Provider Practice Location Address
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Address Line | 300 W CHERRY ST
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City | NEVADA
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State | MO
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Zip | 64772-2202
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Country | US
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Telephone | 417-667-4230
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W CHERRY ST
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City | NEVADA
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State | MO
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Zip | 64772-2202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ROBERT F INGEGNERI
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Credential | PSY.D.
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Telephone | 417-667-4230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 01727
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License Number State | MO
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