MEDICARE: WAYWARD SUN WELLNESS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1902753163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYWARD SUN WELLNESS, LLC

Provider Business Mailing Address
First Line	:	4090 WESTOWN PKWY STE E
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6760
Country	:	US
Telephone Number	:	515-421-8554
Fax Number	:	515-400-1373

Provider Business Practice Location Address
First Line	:	4090 WESTOWN PKWY STE E
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6760
Country	:	US
Telephone Number	:	515-421-8554
Fax Number	:	515-400-1373

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST & OWNER
Name	:	DR. KATHLEEN CAREY MATTHEWS
Credential	:	PHD
Telephone Number	:	515-421-8554

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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