=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952137176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTUITIVE MENTAL & PHYSICAL WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2024
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 W WENGER RD STE J
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45322-2755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-239-5644
-----------------------------------------------------
Fax | 937-771-0031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 W WENGER RD STE J
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45322-2755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-239-5644
-----------------------------------------------------
Fax | 937-771-0031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RHEA J JEFFERS
-----------------------------------------------------
Credential | APRN-CNP, PMHNP-BC
-----------------------------------------------------
Telephone | 937-239-5644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------