Provider Demographics
NPI:1396354874
Name:AFFECTIVE MENTAL WELLNESS LLC
Entity type:Organization
Organization Name:AFFECTIVE MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOENIG-LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:210-360-1590
Mailing Address - Street 1:705 LANDA ST STE E
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6163
Mailing Address - Country:US
Mailing Address - Phone:210-360-1590
Mailing Address - Fax:210-855-9300
Practice Address - Street 1:705 LANDA ST STE E
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6163
Practice Address - Country:US
Practice Address - Phone:210-360-1590
Practice Address - Fax:210-855-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty