Healthcare Provider Details

I. General information

NPI: 1447789581
Provider Name (Legal Business Name): THOUGHTFUL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2017
Last Update Date: 12/19/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E MAIN ST
EPHRATA PA
17522-2508
US

IV. Provider business mailing address

514 E MAIN ST
EPHRATA PA
17522-2508
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-1752
  • Fax: 717-674-7428
Mailing address:
  • Phone: 717-721-1752
  • Fax: 717-674-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHANNA LEAH SCOTT-KLUNK
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential:
Phone: 717-721-1752