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General NPI Number Information
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NPI Number | 1225807217
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Entity Type | Organization
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Legal Business Name | THE PURPLE WELLNESS TRUST INC
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 7613 N BOSWORTH AVE APT 3E
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City | CHICAGO
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State | IL
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Zip | 60626-6244
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Country | US
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Telephone | 312-344-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 7131 W 135TH ST STE 1072
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City | OVERLAND PARK
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State | KS
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Zip | 66223-1238
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BENJAMIN HOWARD
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Credential | MACG, MAED, LCPC
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Telephone | 312-344-3132
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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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