Provider Demographics
NPI:1437791068
Name:PERINATAL WELLNESS INSTITUTE, LLC
Entity Type:Organization
Organization Name:PERINATAL WELLNESS INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BODILY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-699-2839
Mailing Address - Street 1:1480 WOODSTONE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-6872
Mailing Address - Country:US
Mailing Address - Phone:636-699-2839
Mailing Address - Fax:844-641-1015
Practice Address - Street 1:1480 WOODSTONE DR STE 112
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-6872
Practice Address - Country:US
Practice Address - Phone:636-699-2839
Practice Address - Fax:844-641-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty