MEDICARE: WELLNESS STRATEGIES COUNSELING, LLC

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	1041C0700X	Clinical Social Worker
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1841833829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS STRATEGIES COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2020 N ACADEMY BLVD STE 254
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1568
Country	:	US
Telephone Number	:	719-900-4323
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD STE 254
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1568
Country	:	US
Telephone Number	:	719-900-4323
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	CLINTON CALLAHAN
Credential	:	LCSW
Telephone Number	:	719-900-4323

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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