Provider Demographics
NPI:1588352777
Name:NEUROWELLNESS CENTER PLLC
Entity type:Organization
Organization Name:NEUROWELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVACH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-329-6469
Mailing Address - Street 1:3758 E 104TH AVE # 675
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4434
Mailing Address - Country:US
Mailing Address - Phone:720-881-6454
Mailing Address - Fax:720-881-7455
Practice Address - Street 1:12021 PENNSYLVANIA ST STE 108
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3151
Practice Address - Country:US
Practice Address - Phone:720-881-6454
Practice Address - Fax:720-881-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty