Provider Demographics
NPI:1164860037
Name:WELLNESS INX
Entity Type:Organization
Organization Name:WELLNESS INX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MDIV
Authorized Official - Phone:517-272-0520
Mailing Address - Street 1:913 W HOLMES RD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0426
Mailing Address - Country:US
Mailing Address - Phone:517-272-0520
Mailing Address - Fax:517-272-0483
Practice Address - Street 1:913 W HOLMES RD
Practice Address - Street 2:SUITE 275
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0426
Practice Address - Country:US
Practice Address - Phone:517-272-0520
Practice Address - Fax:517-272-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI330345251B00000X
MISA0330345251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management