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General NPI Number Information
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NPI Number | 1316208069
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Entity Type | Organization
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Legal Business Name | WELLNESS PLACE LLC
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 68 CEDAR ST.
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City | KUTTAWA
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State | KY
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Zip | 42055
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Country | US
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Telephone | 270-601-1575
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Fax | 270-350-4673
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | KUTTAWA
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State | KY
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Zip | 42055-0250
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Country | US
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Telephone | 270-601-4235
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Fax | 270-365-4438
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DANIEL KRISTIN JONES
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Credential | PSY.D.
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Telephone | 270-601-4235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1313
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License Number State | KY
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