Healthcare Provider Details

I. General information

NPI: 1285349266
Provider Name (Legal Business Name): WYS WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W JACKSON ST APT 8
MACOMB IL
61455-3635
US

IV. Provider business mailing address

1515 W JACKSON ST APT. 8
MACOMB IL
61455-3635
US

V. Phone/Fax

Practice location:
  • Phone: 309-252-0501
  • Fax:
Mailing address:
  • Phone: 309-252-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MISS XAHARA ALEXANDRIA MEGOD
Title or Position: CEO
Credential: MA, LCPC, R-DMT, CPT
Phone: 309-252-0501