Healthcare Provider Details

I. General information

NPI: 1003335290
Provider Name (Legal Business Name): HEALTHY THOUGHTS WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 E UNIVERSITY AVE STE A
URBANA IL
61802-2811
US

IV. Provider business mailing address

2205 E UNIVERSITY AVE STE A
URBANA IL
61802-2811
US

V. Phone/Fax

Practice location:
  • Phone: 217-419-4713
  • Fax: 217-419-4713
Mailing address:
  • Phone: 217-419-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180.007459
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number180.007459
License Number StateIL

VIII. Authorized Official

Name: NANCY SUZANNE NEUKOMM
Title or Position: THERAPIST/OWNER
Credential: LCPC
Phone: 217-419-4713