Provider Demographics
NPI:1679183255
Name:MIDWEST MENTAL HEALTH THERAPY, PC
Entity Type:Organization
Organization Name:MIDWEST MENTAL HEALTH THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-659-6941
Mailing Address - Street 1:6720 S 188TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3665
Mailing Address - Country:US
Mailing Address - Phone:402-659-6941
Mailing Address - Fax:
Practice Address - Street 1:13304 W CENTER RD STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3453
Practice Address - Country:US
Practice Address - Phone:402-577-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty