Provider Demographics
NPI:1346063138
Name:EVANSVILLE MENTAL HEALTH AND WELLNESS CENTER CO
Entity type:Organization
Organization Name:EVANSVILLE MENTAL HEALTH AND WELLNESS CENTER CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE-BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-901-0825
Mailing Address - Street 1:4972 LINCOLN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7909
Mailing Address - Country:US
Mailing Address - Phone:812-402-3700
Mailing Address - Fax:812-402-4611
Practice Address - Street 1:4972 LINCOLN AVE STE 101
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7909
Practice Address - Country:US
Practice Address - Phone:812-402-3700
Practice Address - Fax:812-402-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty