Healthcare Provider Details

I. General information

NPI: 1679195580
Provider Name (Legal Business Name): WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 W 57TH ST STE 103
SIOUX FALLS SD
57108-5054
US

IV. Provider business mailing address

2333 W 57TH ST STE 103
SIOUX FALLS SD
57108-5054
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-5640
  • Fax:
Mailing address:
  • Phone: 605-271-5640
  • Fax: 605-653-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DAVIS
Title or Position: OWNER
Credential: CSW-PIP
Phone: 605-271-5640