Healthcare Provider Details

I. General information

NPI: 1871001289
Provider Name (Legal Business Name): TRIWELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 W PETERSON AVE STE 201
CHICAGO IL
60646-6183
US

IV. Provider business mailing address

4055 W PETERSON AVE STE 201
CHICAGO IL
60646-6183
US

V. Phone/Fax

Practice location:
  • Phone: 224-518-4547
  • Fax:
Mailing address:
  • Phone: 224-518-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: AARTI S. FELDER
Title or Position: PRESIDENT/CLINICAL DIRECTOR
Credential: MA, LCPC
Phone: 224-518-4547