Organization
MENTAL WELLNESS INC
Active
Other names
Westside Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY JO COOMER BRADFORD CNS, APRN-BC (PRESIDENT)
(507) 779-4795
Entity
Organization
Contact information
Practice address
192 N AVON AVE, SUITE 300, AVON, IN 46123-9513
(317) 672-6400
(317) 672-6401
Mailing address
192 N AVON AVE, SUITE 300, AVON, IN 46123-9513
(317) 672-6400
(317) 672-6401
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
70000195A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730265356
PROVIDER NPI
—
05
—
200285820
—
IN
Enumeration date
03/10/2016
Last updated
04/01/2016
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