Provider Demographics
NPI:1629596812
Name:MENTAL WELLNESS CENTER INC
Entity type:Organization
Organization Name:MENTAL WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BOVEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-807-5077
Mailing Address - Street 1:202 N PROSPECT RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7920
Mailing Address - Country:US
Mailing Address - Phone:309-445-0394
Mailing Address - Fax:309-417-3550
Practice Address - Street 1:205 N WILLIAMSBURG DR STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7721
Practice Address - Country:US
Practice Address - Phone:309-807-5077
Practice Address - Fax:309-214-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty