Healthcare Provider Details

I. General information

NPI: 1669964920
Provider Name (Legal Business Name): VORHEES WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11493 RIESS RD
MASCOUTAH IL
62258-3741
US

IV. Provider business mailing address

11493 RIESS RD
MASCOUTAH IL
62258-3741
US

V. Phone/Fax

Practice location:
  • Phone: 618-789-6029
  • Fax:
Mailing address:
  • Phone: 618-789-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007581
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number180007581
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: JENNIPHER VORHEES
Title or Position: CEO
Credential: LCPC
Phone: 618-789-6029