| Intentional Mental Health & Wellness Pllc | |
|
9626 State Highway 7 E Joaquin TX 75954-3986 | |
| (936) 657-8023 | |
| Not Available |
| Full Name | Intentional Mental Health & Wellness Pllc |
|---|---|
| Speciality | Counselor |
| Location | 9626 State Highway 7 E, Joaquin, Texas |
| Authorized Official Name and Position | Lauren Bonner (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9366578023 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Mental Health & Wellness Pllc 415 County Road 3794 Joaquin TX 75954-2401 Ph: () - | Intentional Mental Health & Wellness Pllc 9626 State Highway 7 E Joaquin TX 75954-3986 Ph: (936) 657-8023 |
| NPI Number | 1336923606 |
|---|---|
| Provider Enumeration Date | 08/18/2023 |
| Last Update Date | 08/21/2023 |
| Certification Date | 08/21/2023 |
| Medicare PECOS PAC ID | 9032569975 |
|---|---|
| Medicare Enrollment ID | O20231219001325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336923606 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Lauren Elizabeth Bonner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568037802 PECOS PAC ID: 0941650881 Enrollment ID: I20231219001561 |
| Provider Name | Ashley Wulf |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467297770 PECOS PAC ID: 5193252005 Enrollment ID: I20241217000578 |