MEDICARE: WHOLE PERSON WELLNESS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1205480993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE PERSON WELLNESS, INC.

Provider Business Mailing Address
First Line	:	501 SE 17TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2224
Country	:	US
Telephone Number	:	239-826-8347
Fax Number	:

Provider Business Practice Location Address
First Line	:	13180 N CLEVELAND AVE STE 214
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-6231
Country	:	US
Telephone Number	:	239-826-8347
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONNA SAN SALVADOR
Credential	:	LMHC, NCC
Telephone Number	:	239-826-8347

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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