Provider Demographics
NPI:1730918061
Name:TOTAL WELL MIND BODY
Entity type:Organization
Organization Name:TOTAL WELL MIND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:GUIRLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERVOIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-791-1839
Mailing Address - Street 1:1 PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 PLEASANT PL
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3005
Practice Address - Country:US
Practice Address - Phone:718-791-1839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty