Healthcare Provider Details

I. General information

NPI: 1306483979
Provider Name (Legal Business Name): NATURAL WELLNESS CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 FERN VALLEY RD
LOUISVILLE KY
40213-3522
US

IV. Provider business mailing address

1468 PLAINFIELD AVE
ORANGE PARK FL
32073-3923
US

V. Phone/Fax

Practice location:
  • Phone: 904-563-0332
  • Fax:
Mailing address:
  • Phone: 904-563-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TOMMIE DOUGLAS BENEFIELD JR.
Title or Position: FOUNDING PARTNER/OWNER
Credential: LHC
Phone: 904-563-0332