Provider Demographics
NPI:1639254600
Name:MENTAL WELLNESS, LLC
Entity Type:Organization
Organization Name:MENTAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYER
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:573-480-7910
Mailing Address - Street 1:1191 HIGHWAY KK
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3510
Mailing Address - Country:US
Mailing Address - Phone:573-480-7910
Mailing Address - Fax:573-302-7239
Practice Address - Street 1:1191 HIGHWAY KK
Practice Address - Street 2:SUITE 202
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3510
Practice Address - Country:US
Practice Address - Phone:573-480-7910
Practice Address - Fax:573-302-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004013642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty