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General NPI Number Information
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NPI Number | 1558835033
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Entity Type | Organization
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Legal Business Name | COLLECTIVE WELLNESS, LLC
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 9666 OLIVE BLVD STE 205
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City | OLIVETTE
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State | MO
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Zip | 63132-3025
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Country | US
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Telephone | 314-884-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 9666 OLIVE BLVD STE 205
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City | OLIVETTE
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State | MO
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Zip | 63132-3025
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Country | US
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Telephone | 314-884-1511
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MADELILNE SEIM
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Credential |
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Telephone | 636-226-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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