Provider Demographics
NPI:1699928093
Name:MENTAL WELLNESS
Entity type:Organization
Organization Name:MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHNUERER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, BC
Authorized Official - Phone:901-457-7871
Mailing Address - Street 1:1125 POPLAR VIEW LN S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3168
Mailing Address - Country:US
Mailing Address - Phone:901-457-7871
Mailing Address - Fax:901-451-7872
Practice Address - Street 1:1125 POPLAR VIEW LN S
Practice Address - Street 2:SUITE 1
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3168
Practice Address - Country:US
Practice Address - Phone:901-457-7871
Practice Address - Fax:901-457-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 7280363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518037662OtherPERSONAL NPI
TN1518037662OtherPERSONAL NPI