Basic Information
| Provider Information | |||||||||
| NPI: | 1083386023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE WELL MIND, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1812 | ||||||||
| Address2: | |||||||||
| City: | MORGAN CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703811812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853546130 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1014 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MORGAN CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703801906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853546130 | ||||||||
| FaxNumber: | 9853546086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2021 | ||||||||
| LastUpdateDate: | 04/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | LENA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9853546130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | 04/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 101YP2500X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 000000 | 01 | LA | NONE | OTHER | 3527511 | 05 | LA | MEDICAID |