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General NPI Number Information
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NPI Number | 1124632492
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Entity Type | Organization
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Legal Business Name | WELLNESS INSTITUTE LLC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 752 BAGNELL DAM BLVD STE B
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City | LAKE OZARK
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State | MO
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Zip | 65049-8716
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Country | US
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Telephone | 573-693-1119
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Fax | 573-557-4163
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Provider Business Mailing Address
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Address Line | 752 BAGNELL DAM BLVD STE B
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City | LAKE OZARK
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State | MO
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Zip | 65049-8716
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Country | US
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Telephone | 573-693-1119
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Fax | 573-557-4163
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MRS. CIBELE F C ELLIOTT
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Credential | MED. / LPC/ EMDR
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Telephone | 573-480-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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