Provider Demographics
NPI:1598657132
Name:FAMILY MENTAL HEALTH WELLNESS LLC
Entity type:Organization
Organization Name:FAMILY MENTAL HEALTH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-208-5484
Mailing Address - Street 1:424 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-4350
Mailing Address - Country:US
Mailing Address - Phone:636-208-5484
Mailing Address - Fax:800-246-0622
Practice Address - Street 1:424 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-4350
Practice Address - Country:US
Practice Address - Phone:636-208-5484
Practice Address - Fax:800-246-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty