| Family Wellness Center Llc | |
|
1551 Sturdy Rd Ste 3 Valparaiso IN 46383-7829 | |
| (219) 531-0111 | |
| (219) 224-4133 |
| Full Name | Family Wellness Center Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1551 Sturdy Rd Ste 3, Valparaiso, Indiana |
| Authorized Official Name and Position | Shannon S Johnson (OWNER) |
| Authorized Official Contact | 2195310111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Wellness Center Llc 1551 Sturdy Rd Ste 3 Valparaiso IN 46383-7829 Ph: (219) 531-0111 | Family Wellness Center Llc 1551 Sturdy Rd Ste 3 Valparaiso IN 46383-7829 Ph: (219) 531-0111 |
| NPI Number | 1295326064 |
|---|---|
| Provider Enumeration Date | 02/03/2021 |
| Last Update Date | 01/18/2024 |
| Certification Date | 01/18/2024 |
| Medicare PECOS PAC ID | 5294173522 |
|---|---|
| Medicare Enrollment ID | O20240405002159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295326064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Shannon Johnson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972859478 PECOS PAC ID: 6103264437 Enrollment ID: I20240405002243 |
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