Provider Demographics
NPI:1619062445
Name:COMPREHENSIVE WELLNESS CLINIC
Entity Type:Organization
Organization Name:COMPREHENSIVE WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCFM
Authorized Official - Phone:417-326-7272
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613
Mailing Address - Country:US
Mailing Address - Phone:417-326-7272
Mailing Address - Fax:417-326-2193
Practice Address - Street 1:714 NORTH POMME DE TERRE ROAD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-326-7272
Practice Address - Fax:417-326-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01322103TC0700X
MORIJ412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty