=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477152809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLOVATION PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2020
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 LOCKHILL SELMA RD STE 210
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78213-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-792-1943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10538 LEGACY CV
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-4475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-792-1943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN AMUNDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-792-1943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------