Provider Demographics
NPI:1235965963
Name:MG WELLNESS CONNECT, LLC
Entity type:Organization
Organization Name:MG WELLNESS CONNECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHEALLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:360-932-5865
Mailing Address - Street 1:409 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2159
Mailing Address - Country:US
Mailing Address - Phone:360-932-5865
Mailing Address - Fax:
Practice Address - Street 1:409 W 32ND ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2159
Practice Address - Country:US
Practice Address - Phone:360-932-5865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health