Provider Demographics
NPI:1407209760
Name:INSIDE WELLNESS MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:INSIDE WELLNESS MENTAL HEALTH LLC
Other - Org Name:INSIDE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-376-8228
Mailing Address - Street 1:3325 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4465
Mailing Address - Country:US
Mailing Address - Phone:801-736-8228
Mailing Address - Fax:
Practice Address - Street 1:3325 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4465
Practice Address - Country:US
Practice Address - Phone:801-736-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT356380-3501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health