Provider Demographics
NPI:1174069371
Name:WELLMIND CENTER, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:WELLMIND CENTER, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-327-6000
Mailing Address - Street 1:1400 N. DUTTON AVENUE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4644
Mailing Address - Country:US
Mailing Address - Phone:707-566-9355
Mailing Address - Fax:707-566-4644
Practice Address - Street 1:1400 N. DUTTON AVENUE
Practice Address - Street 2:SUITE #6
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4644
Practice Address - Country:US
Practice Address - Phone:707-566-9355
Practice Address - Fax:707-566-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER BECK M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty