Provider Demographics
NPI:1093587370
Name:COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GISLON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHC, LADC
Authorized Official - Phone:802-825-4543
Mailing Address - Street 1:2882 PERLEY RD
Mailing Address - Street 2:
Mailing Address - City:ENOSBURG FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05450-5157
Mailing Address - Country:US
Mailing Address - Phone:802-825-4543
Mailing Address - Fax:
Practice Address - Street 1:2882 PERLEY RD
Practice Address - Street 2:
Practice Address - City:ENOSBURG FALLS
Practice Address - State:VT
Practice Address - Zip Code:05450-5157
Practice Address - Country:US
Practice Address - Phone:802-825-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty