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General NPI Number Information
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NPI Number | 1003335290
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Entity Type | Organization
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Legal Business Name | HEALTHY THOUGHTS WELLNESS CENTER
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 2205 E UNIVERSITY AVE STE A
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City | URBANA
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State | IL
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Zip | 61802-2811
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Country | US
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Telephone | 217-419-4713
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Fax | 217-419-4713
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Provider Business Mailing Address
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Address Line | 2205 E UNIVERSITY AVE STE A
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City | URBANA
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State | IL
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Zip | 61802-2811
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Country | US
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Telephone | 217-419-4713
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | NANCY SUZANNE NEUKOMM
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Credential | LCPC
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Telephone | 217-419-4713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180.007459
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 180.007459
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License Number State | IL
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