Provider Demographics
NPI:1376323360
Name:ADVANCED NEURO WELLNESS LLC
Entity Type:Organization
Organization Name:ADVANCED NEURO WELLNESS LLC
Other - Org Name:ADVANCED NEURO HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAPRICE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-351-2220
Mailing Address - Street 1:1490 E FOREMASTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4501
Mailing Address - Country:US
Mailing Address - Phone:435-272-7580
Mailing Address - Fax:
Practice Address - Street 1:1490 E FOREMASTER DR STE 250
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4501
Practice Address - Country:US
Practice Address - Phone:435-351-2220
Practice Address - Fax:435-351-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty