Provider Demographics
NPI:1174281364
Name:BEHAVIORAL WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BEHAVIORAL WELLNESS CENTER LLC
Other - Org Name:SAMANTHA COREY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:517-826-5242
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-0174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:263 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1078
Practice Address - Country:US
Practice Address - Phone:517-826-5242
Practice Address - Fax:517-826-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty