Provider Demographics
NPI:1184423337
Name:COHERENCE MENTAL HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:COHERENCE MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENE
Authorized Official - Middle Name:O
Authorized Official - Last Name:IMUZE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:667-450-8376
Mailing Address - Street 1:336 S MAIN ST STE 2B-A
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3978
Mailing Address - Country:US
Mailing Address - Phone:667-450-8376
Mailing Address - Fax:
Practice Address - Street 1:336 S MAIN ST STE 2B-A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3978
Practice Address - Country:US
Practice Address - Phone:667-450-8376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty