Provider Demographics
NPI:1932773363
Name:MENTAL WELLNESS AND RELATIONSHIP SERVICES LLC
Entity Type:Organization
Organization Name:MENTAL WELLNESS AND RELATIONSHIP SERVICES LLC
Other - Org Name:MENTAL WELLNESS AND RELATIONSHIP SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:208-283-8440
Mailing Address - Street 1:1110 W PARK PL STE 303
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2784
Mailing Address - Country:US
Mailing Address - Phone:208-283-8440
Mailing Address - Fax:208-473-7271
Practice Address - Street 1:1110 W PARK PL STE 303
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2784
Practice Address - Country:US
Practice Address - Phone:208-283-8440
Practice Address - Fax:208-473-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty