MEDICARE: GW & ASSOCIATES/A WELLNESS ORGANIZATION, 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	251S00000X	Community/Behavioral Health Agency	A62970001A	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6297	OTHER	IL	DASA PROVIDER #

General Provider Information

NPI Number	:	1376712372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GW & ASSOCIATES/A WELLNESS ORGANIZATION, INC.

Provider Business Mailing Address
First Line	:	PSC 80
Second Line	:	BOX 14578 APO AP
City	:	OKINAWA
State	:	KADENA AFB
Zip	:	96367
Country	:	JP
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18TH MEDICAL GROUP UNIT 5142
Second Line	:	KADENA AFB OKINAWA JAPAN
City	:	APO
State	:	AP
Zip	:	96368-5142
Country	:	US
Telephone Number	:	816117328210
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GAIL WELLS
Credential	:	LCSW, CADC
Telephone Number	:	3123124289589

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/24/2011

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