Healthcare Provider Details

I. General information

NPI: 1992013619
Provider Name (Legal Business Name): WELLNESS CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W BOXELDER RD STE A1
GILLETTE WY
82718-5320
US

IV. Provider business mailing address

940 E 3RD ST STE 212
CASPER WY
82601-3251
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-7779
  • Fax: 307-686-9494
Mailing address:
  • Phone: 307-577-3050
  • Fax: 307-577-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number299
License Number StateWY

VIII. Authorized Official

Name: KENNETH BELL
Title or Position: OWNER
Credential: PH.D.
Phone: 307-577-3050