Provider Demographics
NPI:1023534914
Name:TMS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:TMS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-497-9657
Mailing Address - Street 1:4132 KEATON CROSSING BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8223
Mailing Address - Country:US
Mailing Address - Phone:314-497-9657
Mailing Address - Fax:
Practice Address - Street 1:4132 KEATON CROSSING BLVD STE 204
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8223
Practice Address - Country:US
Practice Address - Phone:314-497-9657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118786261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)