Provider Demographics
NPI:1952642027
Name:IAMA WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:IAMA WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MONISHA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-437-8918
Mailing Address - Street 1:55 1/2 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2303
Mailing Address - Country:US
Mailing Address - Phone:317-437-8918
Mailing Address - Fax:
Practice Address - Street 1:55 1/2 E COURT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2303
Practice Address - Country:US
Practice Address - Phone:317-437-8918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005728A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty