Healthcare Provider Details

I. General information

NPI: 1043174071
Provider Name (Legal Business Name): KLC WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WALNUT ST STE 403
PHILADELPHIA PA
19102-2903
US

IV. Provider business mailing address

390 COMMERCE DR
FORT WASHINGTON PA
19034-2600
US

V. Phone/Fax

Practice location:
  • Phone: 215-645-2830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATIE CUMMINGS
Title or Position: OWNER
Credential: CRNP
Phone: 215-645-2830