=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144315581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOOSING WELLNESS EAGERLY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 SOUTHWEST BLVD SUITE M
-----------------------------------------------------
City | JEFFERSON CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-893-5521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 SOUTHWEST BLVD SUITE M
-----------------------------------------------------
City | JEFFERSON CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-893-5521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RITA ESTERLY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 573-893-5521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | MO PY 001617
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------