Provider Demographics
NPI:1407475486
Name:CODE 1 WELLNESS
Entity Type:Organization
Organization Name:CODE 1 WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-372-2948
Mailing Address - Street 1:302 S MAIN ST # 258
Mailing Address - Street 2:
Mailing Address - City:ARCHIE
Mailing Address - State:MO
Mailing Address - Zip Code:64725-9608
Mailing Address - Country:US
Mailing Address - Phone:816-372-2948
Mailing Address - Fax:
Practice Address - Street 1:302 S MAIN ST # 258
Practice Address - Street 2:
Practice Address - City:ARCHIE
Practice Address - State:MO
Practice Address - Zip Code:64725-9608
Practice Address - Country:US
Practice Address - Phone:816-372-2948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty