Healthcare Provider Details

I. General information

NPI: 1407246861
Provider Name (Legal Business Name): THE WELLNESS COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105C W WALL ST
HARRISONVILLE MO
64701-2355
US

IV. Provider business mailing address

1304 S. MAIN ST.
HARRISONVILLE MO
64701
US

V. Phone/Fax

Practice location:
  • Phone: 816-974-7378
  • Fax: 816-817-1619
Mailing address:
  • Phone: 816-225-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010021053
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2010036629
License Number StateMO

VIII. Authorized Official

Name: SHANNON HEATHER HISER
Title or Position: OWNER
Credential:
Phone: 916-974-7378