Healthcare Provider Details

I. General information

NPI: 1124632492
Provider Name (Legal Business Name): WELLNESS INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 BAGNELL DAM BLVD STE B
LAKE OZARK MO
65049-8716
US

IV. Provider business mailing address

752 BAGNELL DAM BLVD STE B
LAKE OZARK MO
65049-8716
US

V. Phone/Fax

Practice location:
  • Phone: 573-693-1119
  • Fax: 573-557-4163
Mailing address:
  • Phone: 573-693-1119
  • Fax: 573-557-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CIBELE F C ELLIOTT
Title or Position: CLINICAL THERAPIST
Credential: MED. / LPC/ EMDR
Phone: 573-480-3501