Represent Wellness LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REPRESENT WELLNESS LLC

Practice address

611 28TH Ave
Tuscaloosa, AL 35401-1715

Phone

(205) 409-8248

NPI assigned

Mar 24, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melanie Sharonda Brunner, LICSWNPI 1629663570

Title

Owner/Lead Therapist

Phone

(205) 861-4144

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melanie Sharonda Brunner, LICSW

  • Clinical Social Worker
  • Tuscaloosa, AL
  • NPI 1629663570
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1881271211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 WATERMELON RD APT B",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735183",
            "telephone_number": "205-861-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 28TH AVE",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354011715",
            "telephone_number": "205-409-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REPRESENT WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-24",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "BRUNNER",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "SHARONDA",
        "authorized_official_title_or_position": "OWNER/LEAD THERAPIST",
        "authorized_official_telephone_number": "205-861-4144",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.