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General NPI Number Information
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NPI Number | 1720688591
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Entity Type | Organization
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Legal Business Name | WELLNESS PATH THERAPY CENTER
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 1133 E 83RD ST UNIT 172
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City | CHICAGO
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State | IL
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Zip | 60619-6400
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Country | US
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Telephone | 312-305-1007
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Fax | 773-207-5335
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Provider Business Mailing Address
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Address Line | 1133 E 83RD ST UNIT 172
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City | CHICAGO
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State | IL
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Zip | 60619-6400
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Country | US
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Telephone | 312-305-1007
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Fax | 773-207-5335
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Authorized Official
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Title or Position | LEAD THERAPIST
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Name | AJIBOLA OBAJIMI
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Credential | LCPC
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Telephone | 312-305-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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