Healthcare Provider Details

I. General information

NPI: 1235887233
Provider Name (Legal Business Name): WELLYOU THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N MOUNTAIN AVE STE 203A
UPLAND CA
91786-4165
US

IV. Provider business mailing address

1700 NORTHSIDE DRIVE SUITE A7, UNIT #5965
ATLANTA GA
30318
US

V. Phone/Fax

Practice location:
  • Phone: 631-213-7940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: VICTOR FURTICK
Title or Position: CEO
Credential:
Phone: 631-213-7940