Provider Demographics
NPI:1043846165
Name:SOUND MIND BEHAVIORAL WELLNESS, LLC
Entity Type:Organization
Organization Name:SOUND MIND BEHAVIORAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-601-1406
Mailing Address - Street 1:5726 SOUTHWYCK BLVD STE 200-B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1559
Mailing Address - Country:US
Mailing Address - Phone:567-742-7930
Mailing Address - Fax:419-867-0464
Practice Address - Street 1:5726 SOUTHWYCK BLVD STE 200-B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1559
Practice Address - Country:US
Practice Address - Phone:567-742-7930
Practice Address - Fax:419-867-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444405Medicaid
OH0315327Medicaid
OH01-8165OtherOHIO MENTAL HEALTH & ADDICTION SERVICES
OH0294590Medicaid
OH0178465Medicaid
OH0406325Medicaid