Provider Demographics
NPI:1093344947
Name:TOTAL MENTAL WELLNESS
Entity Type:Organization
Organization Name:TOTAL MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LA NOCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-848-2814
Mailing Address - Street 1:500 E BROWARD BLVD # 1701
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33394-3000
Mailing Address - Country:US
Mailing Address - Phone:954-848-2814
Mailing Address - Fax:
Practice Address - Street 1:500 E BROWARD BLVD # 1701
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33394-3000
Practice Address - Country:US
Practice Address - Phone:954-848-2814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1346676004OtherNPI