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General NPI Number Information
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NPI Number | 1811358492
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Entity Type | Organization
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Legal Business Name | MENTAL WELLNESS INC
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 192 N AVON AVE SUITE 300
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City | AVON
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State | IN
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Zip | 46123-9513
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Country | US
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Telephone | 317-672-6400
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Fax | 317-672-6401
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Provider Business Mailing Address
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Address Line | 192 N AVON AVE SUITE 300
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City | AVON
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State | IN
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Zip | 46123-9513
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Country | US
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Telephone | 317-672-6400
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Fax | 317-672-6401
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TAMMY JO COOMER BRADFORD
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Credential | CNS, APRN-BC
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Telephone | 507-779-4795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 70000195A
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License Number State | IN
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