Provider Demographics
NPI:1033322557
Name:MENTAL WELLNESS CENTERS
Entity Type:Organization
Organization Name:MENTAL WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTINGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-542-1026
Mailing Address - Street 1:500 N GOVERNMENT WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2976
Mailing Address - Country:US
Mailing Address - Phone:208-676-1003
Mailing Address - Fax:208-676-1009
Practice Address - Street 1:500 N GOVERNMENT WAY STE 100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2976
Practice Address - Country:US
Practice Address - Phone:208-676-1003
Practice Address - Fax:208-676-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health