Healthcare Provider Details

I. General information

NPI: 1922693456
Provider Name (Legal Business Name): PROJECT WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E SPRING ST STE B
SAINT MARYS OH
45885-2310
US

IV. Provider business mailing address

150 E SPRING ST STE B
SAINT MARYS OH
45885-2310
US

V. Phone/Fax

Practice location:
  • Phone: 419-954-0102
  • Fax: 419-954-0138
Mailing address:
  • Phone: 419-954-0102
  • Fax: 419-954-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER SMITH
Title or Position: OWNER/CLINICIAN
Credential: LPCC-S
Phone: 614-565-1294