=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528367851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS WORKX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2011
-----------------------------------------------------
Last Update Date | 03/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3632 LAND O LAKES BLVD SUITE 106
-----------------------------------------------------
City | LAND O LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34639-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-504-1462
-----------------------------------------------------
Fax | 813-996-9705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2028
-----------------------------------------------------
City | LAND O LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34639-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-504-1462
-----------------------------------------------------
Fax | 813-996-9705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | JANE YOUNG ARTHUR
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 813-504-1462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | SW 2312
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------