MEDICARE: WELLNESS COUNSELING & CONSULTATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	E. 0004270	OH

General Provider Information

NPI Number	:	1447642186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS COUNSELING & CONSULTATION, LLC

Provider Business Mailing Address
First Line	:	3311 HYDE PARK AVE
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2133
Country	:	US
Telephone Number	:	216-352-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	13110 SHAKER SQ STE C200-E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2373
Country	:	US
Telephone Number	:	216-352-3922
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL COUNSELOR
Name	:	MS. TONYA BLACK
Credential	:	LPCC-S
Telephone Number	:	216-352-3922

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	05/11/2023

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