Provider Demographics
NPI:1144080326
Name:WELLMIND VERMONT, PLLC
Entity type:Organization
Organization Name:WELLMIND VERMONT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LAWRIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:APRN
Authorized Official - Phone:802-417-2039
Mailing Address - Street 1:186 STATE ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-2752
Mailing Address - Country:US
Mailing Address - Phone:802-417-2039
Mailing Address - Fax:802-209-8870
Practice Address - Street 1:186 STATE ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-2752
Practice Address - Country:US
Practice Address - Phone:802-417-2039
Practice Address - Fax:802-209-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty