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General NPI Number Information
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NPI Number | 1154724102
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Entity Type | Organization
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Legal Business Name | THE WELLNESS WORKSHOP, LLC
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 214 S GARRARD ST
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City | RANTOUL
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State | IL
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Zip | 61866-2317
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Country | US
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Telephone | 217-299-3418
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Fax |
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Provider Business Mailing Address
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Address Line | 214 S GARRARD ST
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City | RANTOUL
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State | IL
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Zip | 61866-2317
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Country | US
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Telephone | 217-299-3418
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE ANN BEARD
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Credential | LCPC
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Telephone | 217-299-3418
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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 | 180.009234
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License Number State | IL
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