MEDICARE: WORTHY LIFE WELLNESS, PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1346717147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORTHY LIFE WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	4114 N WATER TOWER PL STE F
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6548
Country	:	US
Telephone Number	:	618-965-8030
Fax Number	:	217-303-5929

Provider Business Practice Location Address
First Line	:	4114 N WATER TOWER PL STE F
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6548
Country	:	US
Telephone Number	:	618-965-8030
Fax Number	:	217-303-5929

Authorized Official
Title or Position	:	LICENSED CLINICAL PROFESSIONAL COUN
Name	:	JESSICA M ASHLOCK
Credential	:	LCPC
Telephone Number	:	618-965-8030

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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