Provider Demographics
NPI:1558059790
Name:MENTAL WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:MENTAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-222-8590
Mailing Address - Street 1:PO BOX 13125
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-3125
Mailing Address - Country:US
Mailing Address - Phone:920-445-8284
Mailing Address - Fax:920-403-7360
Practice Address - Street 1:3431 COMMODITY LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5688
Practice Address - Country:US
Practice Address - Phone:920-445-8284
Practice Address - Fax:920-403-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty