Provider Demographics
NPI:1487282620
Name:AUBURN PSYCHOLOGICAL WELLNESS CENTER LLC
Entity type:Organization
Organization Name:AUBURN PSYCHOLOGICAL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-219-0425
Mailing Address - Street 1:778 N DEAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4315
Mailing Address - Country:US
Mailing Address - Phone:334-219-0425
Mailing Address - Fax:
Practice Address - Street 1:778 N DEAN RD STE 300
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4315
Practice Address - Country:US
Practice Address - Phone:334-219-0425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)