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General NPI Number Information
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NPI Number | 1932773363
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Entity Type | Organization
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Legal Business Name | MENTAL WELLNESS AND RELATIONSHIP SERVICES LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 1110 W PARK PL STE 303
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2784
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Country | US
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Telephone | 208-283-8440
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Fax | 208-473-7271
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Provider Business Mailing Address
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Address Line | 1110 W PARK PL STE 303
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2784
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Country | US
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Telephone | 208-283-8440
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Fax | 208-473-7271
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Authorized Official
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Title or Position | CO-OWNER
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Name | VIOLET F RUDD
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Credential | LMFT
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Telephone | 208-283-8440
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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