Healthcare Provider Details

I. General information

NPI: 1033058557
Provider Name (Legal Business Name): WHOLE LIFE WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16884 BETHLEHEM RD
WINSLOW AR
72959-9710
US

IV. Provider business mailing address

16884 BETHLEHEM RD
WINSLOW AR
72959-9710
US

V. Phone/Fax

Practice location:
  • Phone: 479-388-1571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA NAGEL
Title or Position: PRESIDENT
Credential: LPC
Phone: 479-388-1571