MEDICARE: WELLNESS WORKS

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1649638263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS WORKS

Provider Business Mailing Address
First Line	:	540 W. BROADWAY
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1120
Country	:	US
Telephone Number	:	818-247-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 W. BROADWAY
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1120
Country	:	US
Telephone Number	:	818-247-2062
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. KATHLEEN LYNCH
Credential	:	MA LMFT
Telephone Number	:	818-247-2062

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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Directions to “WELLNESS WORKS ” Practice Location

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