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General NPI Number Information
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NPI Number | 1912611120
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Entity Type | Organization
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Legal Business Name | WORKING CLASS WELLNESS, LLC
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 450 E 4TH ST STE 200
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City | KANSAS CITY
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State | MO
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Zip | 64106-1178
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Country | US
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Telephone | 702-701-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 302 CRESTVIEW CT
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City | RAYMORE
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State | MO
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Zip | 64083-8703
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Country | US
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Telephone | 702-701-6110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARISSA CLARK
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Credential | LMT
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Telephone | 702-701-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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