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General NPI Number Information
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NPI Number | 1760219786
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Entity Type | Organization
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Legal Business Name | ELITE WELLNESS CENTER
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Dates
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Enumeration Date | 09/14/2024
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Last Update Date | 09/14/2024
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Provider Practice Location Address
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Address Line | W156N8327 PILGRIM RD STE 101
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3776
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Country | US
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Telephone | 262-955-7878
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Fax |
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Provider Business Mailing Address
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Address Line | W156N8327 PILGRIM RD STE 101
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3776
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Country | US
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Telephone | 262-955-7878
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | DR. CAROLYN G ANDERSON
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Credential |
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Telephone | 262-955-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #5
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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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