MENTAL WELLNESS INC (NPI# 1811358492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811358492 |
| Entity Type | Organization |
| Organization Name | MENTAL WELLNESS INC |
| Other Organization Name | WESTSIDE MENTAL HEALTH |
| Practice Address |
192 N Avon Ave Suite 300 Avon IN 46123-9513 |
| Practice Telephone | 3176726400 |
| Practice Fax Number | 3176726401 |
| Mailing Telephone | 3176726400 |
| Mailing Fax Number | 3176726401 |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-04-01 |
| Authorized Official Name | MRS. TAMMY JO COOMER BRADFORD (PRESIDENT) |
| Authorized Official Telephone | 5077794795 |
| Authorized Official Credential | CNS, APRN-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0808X |
Clinical Nurse Specialist Specialization: Psych/Mental Health |
70000195A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200285820 | 05 | |
| PROVIDER NPI | 1730265356 | 01 |
| Other Name | Type Code |
|---|---|
| Westside Mental Health | Doing Business As Name - Organization |
| Street Address |
192 N AVON AVE SUITE 300 |
| City | AVON |
| State | IN |
| Zip Code | 46123-9513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245497973 | Jennifer G Robertson | Counselor | 192 N Avon Ave, Ste 300, Avon, IN 46123-9513 | 2008-05-20 |
| 1376086314 | Three Lakes Counseling LLC | Counselor | 192 N Avon Ave, Ste 300, Avon, IN 46123-9513 | 2016-11-23 |
| 1295189652 | Nlt Counseling Service LLC | Community/Behavioral Health | 192 N Avon Ave, Suite 300, Avon, IN 46123-9513 | 2016-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669018669 | Dienye Williams | Pharmacist | 108 North Sr 267, Avon, IN 46123 | 2019-11-25 |
| 1992353817 | Debra Blackwell | Technician | 8198 Montage Ave, Apt 104, Avon, IN 46123 | 2019-09-04 |
| 1932675766 | Blake Ponist | Occupational Therapist | 10940 E U S Highway 36, Rockville Rd, Avon, IN 46123 | 2018-10-19 |
| 1396238150 | Sarah Sweany | Dietitian, Registered | Iu Health West Cancer Center, 1111 North Ronald Reagen Pkwy Suite B1600, Avon, IN 46123 | 2018-06-07 |
| 1124516257 | Sheree Itza | Counselor | 6655 E Us Highway 36 Ste 100, Avon, IN 46123 | 2018-04-24 |
| 1255860607 | Jonathan Lambert | Dentist | 110 N Avon Ave B, Avon, IN 46123 | 2017-06-08 |
| 1023546629 | 10439 E Us Highway 36 Dental, LLC | Dentist | 10439 E Us Highway 36, Avon, IN 46123 | 2017-05-25 |
| 1902330756 | Melissa Wheatley | Occupational Therapy Assistant | 6294 Forest View Court, Avon, IN 46123 | 2017-04-19 |
| 1932555844 | Gal Marcan | Family Medicine | 1351 Ronald Reagan Pkwy Ste B, Avon, IN 46123 | 2016-05-10 |
| 1962871301 | Annette Joelene Oechsle | Health Educator | 1820 South County Road 525 East, Avon, IN 46123 | 2015-09-16 |
| Find all providers in zip 46123 | ||||
| Taxonomy Code | 364SP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336262989 | Cara Marie Bartos | Clinical Nurse Specialist | 152 Simsbury Road, Building 9, Avon, CT 06001 | 2007-04-09 |
| 1083769590 | Nicholas Roy Gilbert | Clinical Nurse Specialist | 152 Simsbury Rd, Building 9, 2nd Floor, Avon, CT 06001-3777 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053650887 | Gerald Lewis Inc. | Clinical Nurse Specialist | 1150 Eastport Centre Dr, Suite D, Valparaiso, IN 46383-8427 | 2013-02-14 |
| 1437497864 | Abidemi Mary Ajuwon | Clinical Nurse Specialist | 3420 Cinnabar St, West Lafayette, IN 47906-7208 | 2013-01-18 |
| 1952603664 | Tara Elizabeth Gavardinas | Clinical Nurse Specialist | The Indiana Clinic, 340 W. 10th Street, Fs 5100, Indianapolis, IN 46202 | 2010-12-01 |
| 1407014327 | Regina Dawn Haight | Clinical Nurse Specialist | 1701 N Capitol Ave, C-3, Indianapolis, IN 46202-1203 | 2008-05-28 |
| 1073780102 | Deborah Lynn May | Clinical Nurse Specialist | 10748 Weston Dr, Carmel, IN 46032-9319 | 2008-05-08 |
| 1245403419 | Carol Agnes Essenmacher | Clinical Nurse Specialist | 8075 N Shadeland Ave Ste 350, Indianapolis, IN 46250-2693 | 2008-04-09 |
| 1508041716 | Elisabeth K Degenhardt | Clinical Nurse Specialist | 5230 E Stop 11 Rd Ste 300, Indianapolis, IN 46237-6401 | 2008-01-07 |
| 1306999131 | Kathleen R Lynch Lewis | Clinical Nurse Specialist | 281 Bielby Rd, Lawrenceburg, IN 47025-1055 | 2007-01-18 |
| 1831207000 | Frances Lucille Miller | Clinical Nurse Specialist | 145 Green Meadows Drive, Greenfield, IN 46140-4001 | 2006-08-28 |
| 1558308841 | Jennifer G Sims | Clinical Nurse Specialist | 1481 W 10th St # C-5085, Richard L Roudebush Va Medical Center, Indianapolis, IN 46202-2803 | 2006-06-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.