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General NPI Number Information
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NPI Number | 1568273159
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Entity Type | Organization
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Legal Business Name | THE LIVING ROOM WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1050 E WALNUT ST STE A
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City | SPRINGFIELD
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State | MO
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Zip | 65806-2637
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Country | US
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Telephone | 417-413-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 E WALNUT ST STE A
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City | SPRINGFIELD
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State | MO
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Zip | 65806-2637
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Country | US
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Telephone | 417-413-4774
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. CHELSEA GILLIAM, PSY.D.
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Credential | PSYD
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Telephone | 417-274-0297
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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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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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