Provider Demographics
NPI:1235813932
Name:LINNBERRY WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:LINNBERRY WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LMFT
Authorized Official - Phone:479-366-2279
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-0285
Mailing Address - Country:US
Mailing Address - Phone:479-366-2279
Mailing Address - Fax:
Practice Address - Street 1:20655 RUSSELL CORNER RD
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-8955
Practice Address - Country:US
Practice Address - Phone:479-366-2279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty