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General NPI Number Information
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NPI Number | 1407634819
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Entity Type | Organization
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Legal Business Name | WELLNESS PATH COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 3245 GROVE AVE STE 208
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City | BERWYN
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State | IL
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Zip | 60402-3476
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Country | US
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Telephone | 847-220-7286
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1302
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City | BARRINGTON
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State | IL
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Zip | 60011-1302
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Country | US
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Telephone | 847-220-7286
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEISY RODRIGUEZ
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Credential | LCPC
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Telephone | 847-220-7286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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