Healthcare Provider Details

I. General information

NPI: 1720925357
Provider Name (Legal Business Name): WELLNESS ESSENTIALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 HIDDEN DR
MONTICELLO KY
42633
US

IV. Provider business mailing address

PO BOX 1092
MONTICELLO KY
42633-4092
US

V. Phone/Fax

Practice location:
  • Phone: 606-307-3043
  • Fax:
Mailing address:
  • Phone: 606-307-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LOUIS BERTRAND GRAVES III
Title or Position: OWNER/THERAPIST
Credential: CSW
Phone: 606-307-3043