Healthcare Provider Details

I. General information

NPI: 1215868252
Provider Name (Legal Business Name): WELLNESS THERAPY CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 N 4TH ST STE 201
COEUR D ALENE ID
83814-3100
US

IV. Provider business mailing address

1022 N 4TH ST STE 201
COEUR D ALENE ID
83814-3100
US

V. Phone/Fax

Practice location:
  • Phone: 208-449-6491
  • 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: SYDNEY STEVENS
Title or Position: OWNER
Credential:
Phone: 208-449-6491