Provider Demographics
NPI:1083381081
Name:INSIGHT WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:INSIGHT WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC
Authorized Official - Phone:708-308-3164
Mailing Address - Street 1:3741 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-8051
Mailing Address - Country:US
Mailing Address - Phone:708-308-3164
Mailing Address - Fax:
Practice Address - Street 1:525 E NORTH ST STE F
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1186
Practice Address - Country:US
Practice Address - Phone:708-522-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)