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General NPI Number Information
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NPI Number | 1396601084
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Entity Type | Organization
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Legal Business Name | SELF CONNECT WELLNESS, LLC
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Dates
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Enumeration Date | 12/26/2025
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 800 N 6TH ST
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City | HIAWATHA
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State | KS
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Zip | 66434-1717
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Country | US
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Telephone | 785-992-1531
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 91
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City | HIAWATHA
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State | KS
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Zip | 66434-0091
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Country | US
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Telephone | 785-741-1708
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. DUSTIN WILLIAMS
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Credential | APRN
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Telephone | 785-741-1708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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