Healthcare Provider Details

I. General information

NPI: 1225965601
Provider Name (Legal Business Name): THE WELLNESS PATH CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 N LEAVITT ST
CHICAGO IL
60622-1820
US

IV. Provider business mailing address

2439 N MONTICELLO AVE
CHICAGO IL
60647-2322
US

V. Phone/Fax

Practice location:
  • Phone: 847-278-9757
  • Fax:
Mailing address:
  • Phone: 847-278-9757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN DE LA TORRE JR.
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 312-952-0979